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ELECTRO-THERAPEUTICS 



JDR. WILHELM ERB, 

VBOVIMOIB n THB UJUVMmx r OF IXIPSIO 



THANSLATKD BT 

L. PUTZEL, M.D., 

nmOLOOIR TO XAVDALL*! IBLAHD BOSPITALi, AHD FHTnOIAH TO THB 011X10 WfM MaE fOWi 

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WILLIAM WOOD & COMPANY 

66 & 58 Lafayette Place 

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WILUAM WOOD & COMPANY 
1888 



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TABLE OF CONTENTS. 



PART J. 
PHYSICAL INTRODUCTION. 

LBCTURE I. 

The Yarions Kinds of Onrrents — Oontaot Eleotridty; the Qalvanio Omrent — Gil* 
Tanio Circuits— Indnotion Eleotricity ; the Faradio Current — The Ordinaiy Ap- 
paratus and Auxiliary Apparatus ; Induction Apparatus and Galyanio Bat- 
teries pp. 1-10 

LECTURB II. 

Aeeeasory Apparaios; Selector or Element Numerator —Polaritj Changer— GalTa- 
nometer — Measurement of the Absolute Strength of the Current— Rheostat — Con* 
ducting Wires — Electrodes and their Various Forms — ^Electrical Table — Physioal 
and Physiologioal Recognition of the Poles pp. 11-18 

LECTURE IIL 

Phyrioal Laws of the Diffusion of the Current and their Application in Electro-thera- 
peutics — Ohm*s Lav — Strength of Current— Resistance of Varions Condnctors: 
Besistanoe of the Animal Tissues, especially the Epidermis — Individual Differ- 
enoas in Man and their Consequences — Essential and Extra-essential Resistance ; 
Conclusions therefrom Concerning the Construction of Apparatus — Density of the 
Current and its Laws — Practical Deductions for Various Electro- therapeutioal 
Purposes— Electrolytic and Cataphoric Efleoto pp. ld-83 



PART 11. 
PHYSIOLOGICAL mTRODUCTION. 

LECTURE IV. 

SffsolB of Sleotrical Currents on the Healthy Living Body — Eleotro-physlology of 
the Motor Nerves and the Muscles — Stimulant Action — Pflaeger*s Law of Con- 
traction — Action of the Poles— Law of Contraction of the Motor Nerves in the 
Living Body— Polar Method of Examination — Law of Polar Contraction and its 

225468 



IV CONTENTS. 

Different Grades— Fazadic and Galyanio Baaotion of the Moades— Eleotrotooio 
Phenomena— EleotrotonnB in the Living Body — Modifying and Exhilarating 
Effects PP.88-4S 

LEGTUBB y. 

Electro-physiology of the Sensoiy Nenrea and Nerres of Special Sense— Sensory 
Nerves of the Skin and their Law of Contraction — Sensoiy Nerves of the Mnsdes 
— Optic Nerve and Betina — Acoustic Nerve and the Nervons Auditory Apparatus 
— ^Nerves of Taste — ^Nerves of Smell pp. 44-40 

LECTUEE VI. 

Electro-physiology of the Secretory and Vasomotor Nerves — Cervical Sympathetio— 
Effect of Electrical Currents on the Skin — Electro-physiology of the Brain and 
Spinal Cord — Phenomena in Ckdvanization of the Brain and Spinal Cord in Man — 
^ Electro-physioloj^ of the Organs of the Thorax and Abdomen — Electrolytic and 
Cataphoric Effects — Galvanic Introduction of Drugs into the Body — Bemak*s 
Oatalytio Effects — Indirect Catalyses pp. 60-57 



PART III. 

METHODS OF ELECTRICAL EXAMINATION AND ELEC- 
TRO-DIAGNOSIS. 

LECTURE Vn. 

The Methods of Electrical Examination — Examination of the Motor Nerves and Mns- 
des — ^Polar Method — General Rules — Method of Quantitative Examination of 
Irritability with the Faradic and Galvanic Currents — Method of the Qualitative 
Examination of Irritability — Examination of the Eye — Examination of the Audi- 
tory Apparatus — Galvanic Examination of Taste— Examination of Electro-catan- 
eons Sensibility— Electro-muscular Sensibility pp. 59-68 

LECTURE Vm 

Pathological Changes of Electrical Irritability and their Diagnostic Significance — A. 
EleotroHliagnosis of the Motor Nerves and Muscles — 1. Increase — 3. Diminution 
of Electrical Irritabilit<y— 8. Degeneration Reaction — Description of De R — Its 
Course— Increased Mechanical Irritability pp. 09-78 

LECTURE IX. 

8. Degeneration Reaction (continued) — Its Relation to Degenerative Atrophy of the 
Motor lArves and the Muscles. Their Description — Comparison of their Course 
vrith that of the De R— Complete and Partial Degeneration Reaction — Occurrence 
of the De R — Diagnostic Conclusions therefrom — Its Prognostio Significance — 
Special and Critical Remarks pp. 79-88 



OONTICNTS. 



LBCTUBB X. 

4. Barer QaantitatiTe and Qualitative ChaDg^ of Electrical Irritability: a, Inoreaae 
of Secondarj Irritabilily (Convulsible Reaction) — b. Diminution of Secondary 
Irritability (Exhaustion Reaction)— o. Qualitative Changes in the Law of Gon- 
traction of Motor Nerves— (f. Different Reaction of the Nerves to the Faradic and 
Qalvanic Currents — e. Latent Period of Irritation in Faradic Stimulation of the 
Muscles—/. Diplegic Contractions — B. Electro-diagnosis of the Sensory Nerves — 
Anomalies of Farado-cutaneous and Farado-muscular Sensibility pp. 89-04 

LECTURE XI. 

C EleotrO'diagno^is of the Nerves of Special Sense. 1. Optic Nerve and Retina — 2. 
Acoustic Nerve and Auditory Apparatus- -a. Simple Galvanic Hypersesthesia — b. 
Hypenesthesia with Change and Reversal of Normal Formula— o. Qualitative 
Anomalies without Hyperadsthesia — d. Torpor — 3. Nerves of Taste — Electro-diag- 
nosis of the Vasomotor Nerves, the Sympathetic, Pneumogastric, Central Ner- 
Tona System, etc , pp. 95-109 



FAMT IV. 
GENERAL ELECTRO-THERAPEUTICS. 

LECTURE XXL 

The Therapentio Value of Electricity— Various Electro-therapeutio Theories — Empi- 
rical Standpoint— Available Effects of the Current and the Method Employed — 
Stimulating, Modifying (Refreshing), Catalytic Effects — Empirical Basis of the 
Latter — Direct and Indirect Catalysis — Therapeutic Oalvanization of the Cervical 
Sympathetio— Reflex Effects of the Current pp. 103-113 

LECTURE Xin. 

Methods of Therapeutic Applications in Local Diseases — Polar or Direction Method ? 
— Advantages of the Polar Method — Empirical Methods— Influence upon the (Gen- 
eral Organism: 1. General Faradization (according to Beard and Rockwell) ; 8. 
General (Galvanization ; 8. Central Galvanization (Beard) ; 4. The Electrical Bath 
— Special Methods of Treatment : 1. Galvanic Treatment of Pressure and Painful 
Pointe; 2. Treatment with Feeble, Continuous, Galvanic Currents. . pp. 118-120 

LECTURE XIV. 

General Principles and Special Technical Recommendations for Electrical Treatment 
— Treatment in Loco Morbi— Technique of the Localization of the Current — 
Local Faradization of the Motor Nerves and the Muscles— Plan of Treatment — 
Personal Acquaintance with the Effects of the Current— Choice of the Strength of 
the Current — Choice and Management of the Electrodes— Avoidance of Unneces- 
sary Irritative Effects — Duration and Frequency of the Individual Applications — 
Entire Duration of Treatment pp. 121-184 



yi OONTBITDS. 

PART V. 
SPECIAL ELECTRO-THERAPEUTICS. 

iHTRODuonoH pp. 185-186 

I. DISEASES OF THE BBAIN, IXGLUDIXG THE PSYCHOSES. 

LECTURE XV. 

Introdaotoxy Remarks — ^Physiologioal, Experimental, and Theoretical BaalB of Electro- 
therapeutics of the Brain— Therapeutical Facta— Collection of a Series of Indi- 
vidual Observations — Conclusions therefrom — Negative or Partial Curative Effects 
— The Forms of Disease in which Electro-therapeutic Success may, and those in 
which it may not, be expected pp. 187-147 

LECTURE XVL 

Development of Electro-therapeutical Methods — Direct Treatment of the Brain : Cat- 
alytic and Vasomotor Effects and the Methods of Producing them — Stimulating 
and Modifying Effects— Technique of the Application of the Galvanic and Faradic 
Current in Cerebral Diseaaas — Indirect Treatment of the Brain : Galvanization of 
the Sympathetic— Reflex Effects from the Skin — Symptomatic Treatment — Elec- 
tro-diagnosis in Cerebral Diseases — Eleotro-therapeutics of Individual Forms of 
Disease : Cerebral Neurasthenia ; Insomnia ; Hyperemia ; Ansmia ; Hemor- 
rhage ; Cerebral Softening ; Inflammation ; Degeneration ; Sclerosis, etc. ; Bulbar 
Diseases — Incurable Cerebral Affections. pp. 148-155 

APPENDIX. 

ELEOTRO-THERAPEUTIOS OF THE PSYCHOSES- 
LECTURE XVIL 

Introduction — Investigations of Amdt and their Results— Short R^sum^ of the Litera- 
ture — Available Effects of the Electrical Current — Rules and Methods of Electri- 
cal Treatment of Individual Forms of Psychoses — Treatment of Individual 
Symptoms pp. 156-159 

n. DISEASES OF THE SPINAL OORD. 

LECTURE XVIIL 

Intiodaction— Physiological and Theoretical Basis for the Electro-therapeutics of the 
Spinal Cord — Therapeutical Data ; Selected Cases— Conclusions therefrom- 
Therapeutic Failures— Forms of Spinal Disease in which Electro-therapeutic Sue- 
oess may be expected — Methods and Technique of Electro- therapeutics of the 
Spinal Cord— Direct Treatment: Action of the Poles and the Direction of the 



CONTENTS. VU 

Oonenb— Methods of Applioation in Ciroamsoribed snd Longitadiiial Diaeasee— 
Indirect Treatment : From the Sympathetic ; Combined Treatment of the Sym- 
pathetic — Beflex from the Integument — Diplf^gio Irritation — Treatment of Points 
«f PreBBoze and Points I>onloareux->S7mptomatio Treatment pp. 100-169 

LBCTUBE XIX. 

treatment of IndiTidnal Forms of Spinal Disease — Eleetro-diagnoetio Prelimlnaiy 
Remarks — 1. Spinal Meningitis — 2. Meningeal Apoplexy— 3. Functional Diseases 
of the Cord ; Ccncnssion, Spinal Irritation, Spinal Nenrasthenia — 4. Hemor- 
rhages into the Spinal Cord : Severe Traumatic Lesions — 5. Myelitis ; Multiple 
Sclerosis — 6. Tabes Dorsalis ; Direct Galyanic Treatment ; Treatment of the 
Painful Points ; Farado-cutaneous Brush — 7. Spastic Spinal Paralysis — 8. Acute 
Anterior Poliomyelitis; Electrical Examination; .Electrical Methods of Treat- 
ment — 9. Subacute and Chronic Anterior PoliomyelitiB — 10. Progressive Muscular 
Atrophy ; Condition of the Electrical Irritability ; '* Juvenile " Form ; Method of 
Treatment; Amyotrophic Lateral Sclerosis— 11. Acute Ascending Paralysis — 12. 
Secondary Degeneration. pp. 170-179 



UL DISEASES OF THE PEBIPHEBAL NEBVES. 

LECTURE XX 

iBtvoduction — Ayaifakble Current Effects in Diseases of the Peripheral Nerres— Practi- 
cal Experience : Cases — Technique and Methods of Electrical Treatment — Indi- 
vidual Forms of Disease: Neuritis; Hemorrhages and Circulatory Disorders; 
Slight Mechanical and Traumatic Lesions ; Severe Traumatic Lesions ; Degener- 
ative Atrophy of the Nerves ; Functional Disorders — Symptomatic Treatment— 
Bleotxo-diagnostic Remarks. pp. 180-186 

IV. PABALYSIS AND ATROPHY. 

LECTURE XXI. 

Definition and Pathogenesis of ParalysiB— Objects of Electro-therapeutics in Paralysis 
and the Methods of Effecting them : a. Removal of the Cause of Paralysis— 6. 
Removal of Obstructions to Motor Conduction; Direct and Indirect Method; 
Utilization of Reflex Paths ; Method of Application of the Faradic and Galvanic 
Currents for these Purposes — c. Relief of Finer or Grosser Nutritive Disturbances 
in the Motor Conducting Paths— (2. Restoration of the Normal Condition of the 
Paralysed Musoles— Treatment of Muscular Atrophy —Results of Electro-theza- 
peatios in Paralysis — ^Electro-diagnosis of Paralyses—Practical Technical Re- 
■larkB pp. 187-195 

LECTURE XXII. 

Ileeteo-therapentics of Individual Forms of Paralysis— 1. Paralysis of the Ocular 
Muscles : Pathogenesid ; Cases ; Methods of Treatment ; Results — 3. Paralysis 
of the Muscles of Mastication— 3. Paralysis of the Facial Nerve: Rheomatio 



VIU CONTENTS. 

Form; its Situation and Natnxe; Condition of Electrical Excitability; Frog- 
noaa ; Caaea ; Methods of Treatment ; Resolts — Other Forms of Facial ParalTsia 
—4. Paralysis of the Spinal Aooessory Nerve— 5. Paralysis of the Hypoglo«al 
Nerre pp. 195-905 

LECTURE XXm. 

Blectro-therapentics of Individoal Forms of Paralysii (oontinned) — 6. Paralyses of 
the Neck andTnink: Pathogenesis; Cases; Methods of Treatment — 7. Paraly- 
ses of the Upper Limbs : Pathogenesis ; Symptomatology ; Electro-diagnosis ; 
Cases ; Methods of Treatment ; Results — 8. Paralyses of the Lower Limbs : 
Pathogenesis and Lidividoal Varieties; Electro-diagnosis; Cases; Methods of 
Treatment; Results pp. 206-218 

LECTURE XXIV. 

Electro-therapeutics of Individual Forms of Paralysis (conclusion) — 9. Paralysis of 
the Velum Palati and Pharynx ; Paralysis of Deglutition : Pathogenesis ; Cases ; 
Methods of Treatment — 10. Paralysis of the Laryngeal Muscles ; Paralysis of the 
Vocal Cords : Character and Methods of Treatment ; Percutaneous and Endo- 
Laryngeal Application ; Results — 11. Paralysis of Respiration ; Artificial Respira- 
tion; Rhythmical Faradization of the Phrenics — 12. Diphtheritic Paralysis: 
PathogeneslB and Symptoms ; Cases ; Electrical Treatment ; Galvanization of the 
Heart; Results — 13. Lead Palsy and other Toxic Paralyses: Characteristics of 
Lead Palsy ; Electrical Excitability ; Situation and Character of the Disorder ; 
Method of Treatment— 14. Muscular Atrophy and Hypertrophy : Purely Muscu- 
lar Atrophy ; Atrophy in Articular Affections ; Cases ; Treatment ; Muscular 
Hypertrophy ; Congenital Myotonia pp. 219-238 

V. PAIN. NEURALGIA AND NEURALGIFORM AFFECTIONS. 

LECTURE XXV. 

Introduction— Definition and Naturu of Pain and Neuralgia— The Neuralgic Change — 
Electro-therapeutic Objects: Removal of the Abnormal Nutritive Conditions in 
the Nerves and of the Causes of the Neuralgic Change ; the Actions of the Cur- 
rent Available for this Purpose ; Cases — Electro-therapeutic Methods ; Causal 
Treatment — Anti-neuralgic Methods : Direct Application of the Galvanic and the 
Faradio Current; Indirect, Electro-cutaneous Brush; Galvanic Treatment of 
Painful Points— General Plan of Treatment— Results pp. 284-244 

LECTURE XXVL 

Individual Forms of Neuralgia: 1. Trigeminal Neuralcfia; Practical Remarks Con- 
cerning the Individual Methods of Treatment -2. Cervico-occipital Neuralgia--^ 
Headache and Migraine; Various Methods of their Treatment— 4. Cervico-bra- 
chial Neuralgia — 5. Intercostal Neuralgia— 6. Neuralgia of the Lumbar P!exus— 
7. Sciatica ; Various Methods of Galvanic and Faradio Treatment ; Neuralgia of 
the Urinary and Sexual Organs ; Coccygodynia — 8. Neuralgias of the Joints— 9. 
Visceral Neuralgias : Neuralgia of the Pharynx and Larynx ; Angina Pectoris » 
Gastralgia ; Enteralgia ; Lead Colic ; Neuralgia in the Distribution of the Pelvic 
Nerves pp. 246-268 



CONTENTS. IX 



YL SPASM AND OONTBAGTUBE. 

LBOTURB XXVn. 

Introdootloii : Character and Pathogenesis of Spasms; the Spastic Change — The 
Electrical Irritability^Electro-therapeatic Objects: Relief of the Direct Motor 
Irritation ; Removal of Reflex Stimali ; Production of Vigorous Inhibition ; Cases 
— Electro-therapentic Methods ; Causal Treatment ; Direct Antispastic Treatment 
and its Methods ; GhUvanic and Faradic ; General Plan of Treatment ; Results — 
Individual Forms of Spasm : Spasms of the Muscles of Mastication ; Mimic 
Facial Spasm ; Blepharospasm ; Spasm in the Distribution of the Spinal Acces- 
sory and in the Neck ; Spasm in the Muscles of the Trunk ; Respiratory Spasm, 
Singultus, eta ; Spasms in the Upper and Lower Limbs pp. 259-279 



Vn. AN.ESTHESIA. 

LECTURE XXVni. 

Character and Pathogenesis of Anaasthesia— Electrical Examination — Objects of Eleo» 
tro-therapeutics ; Cases — Methods of Electrical Treatment: Causal Treatment^ 
Direct Treatment of Ansesthesia ; Methods with the Faradic and Galvanic Cur- 
rents; Relief of Secondary Trophic DiBturbances ; Results — Individual Forms: 
Ansdsthesia of the Trigeminus, the Pharynx and Larynx; Vasomotor Anassthe- 
sia ; Hysterical Anaesthesia ; Ataxic Anaesthesia pp. 273-270 



Vin. DISEASES OF THE CERVICAL SYMPATHETIC— VASOMOTOR, 

TROPHIC, AND ALLIED NEUROSES. 

LECTURE XXDL 

Diseases of the Cervical Sympathetic ; Occurrence and Symptoms ; Irritation and 
Paralysis; Methods of Electrical Treatment — ^Vasomotor Neuroses — Cutaneous 
Angioneuroses — Symptoms of Spasm and Paralysis of the Vasomotor Neuroses ; 
Methods of Electrical Treatment — Intermittent Dropsy of the Joints — ^Vasomotor 
Trophic Neuroses of the Integument — ^Anomalies of the Secretion of Perspira- 
tion — Progressive Facial Hemiatrophy ; Probable Site ; Methods of Electrical 
Treatment — Scleroderma ; Method of Treatment pp. 280-287 



n GENERAL NEUROSES.— CENTRAL AND OTHER FUNCTIONAL 

NEUROSES. 

LECTURE XXX. 

ThMTy of the Functional Neuroses — Electro-therapeutic Objects : Removal of the Local 
Nutritive Disturbances ; Influence upon the Entire Nervous System and the En- 
tire Organism ; Removal of Definite Causes of Disease ; Treatment of Individual 
6ymptoma~l. Neurasthenia : Various Forms; Nature of the Disease; Methods 



I 

I 



Jl OONTE17T6. 

of Treatment ; BeBolte— d. HypoehondriaoB— 3. Hysteria ; ite Nature, Object, 
and Methods of Electrical Treatment— 4 EpUepfj— 5. Co-ordinate Professional 
Hyperkineses ; Writer's Spasm ; Varions Forms ; Methods of Treatment — fi. 
Chorea Magna. pp. 288-297 

LECTURE XXXI. 

7. Chorea Minor : Its Situation and Character ; Electrical Treatment—S. Tetanus : 
Methods of Treatment — 9. Tetany : Its Characteristics : Electrical Excitability ; 
Character and Location of the Disease; Electrical Treatment — 10. Catalepsy — 
11. Tremor — 12. Paralysis Agltans — 13. Athetosui — 14. Basedow's Diaease : 
Symptoms and Location of the Disease ; Methods of Electrical Treatment — 15. 
Vertigo— lt(. Diabetes Mellitus and Insipidus. pp. 298-306 

X. DISEASES OF THE ORGANS OF SPECIAL SENSE. 

LECTURE XX XII. 

Introduction — Diseases of the Visual Apparatus : Their Electro-diagnosis — Diseases of 
the Lids, Conjunctiva, Cornea, Iris, Lens, Vitreous Body, Choroid — Diseases of 
the Retina and Optic Nerve : Retinitis Pigmentosa ; Papillitis and Papillo-retinl- 
tis ; Optic Neuritis ; Cases ; Method of Treatment — Atrophy of the Optic Nerve : 
Tabetic and Geuuine Atr<9phy ; Cases ; Treatment — Amaurosis without Anatomi- 
cal Lesion — Hemianopsia — Diseases of the Ocular Muscles : Insuffldenc^ of the 
Intern! ; Accommodative Asthenopia ; Mydriasis ; Nystagmus pp. 306-315 

LECTURE XXXni. 

of the Auditory Apparatus— Introduction — Dryness of the Auditory Canal — 
Opacities of the Membrane — Diseases of the Auditory Nervous Apparatus : Ner- 
vous Tinnitus Aurium ; Its Relations to Galvanic Reaction ; Electro-diagnosis ; 
Therapeutic Indications ; Determination of the Method of Treatment ; Cases ; 
Principles of Treatment ; Special Procedures in Individual Cases ; General Rules 
and Technical Remarks ; Results — Nervous Deafness ; Cases ; Method of Treatment 
—Deaf -mutism — Meniere's Disease — Neuroses of the Gustatory Nerves ; Ageusis 
— Neuroses of the Olfactory Nerves : Anosmia and its Treatment . . . pp. 316-326 



XL DISEASES OF THE ORGANS OF IiOCX)MOTION, THE GLANDS, 
THE THORACIC VISCERA, AND THE DIGESTIVE APPARATUS. 

LECTURE XXXIV. 

Diseases of the Organs of Locomotion: Muscular Rheumatism; its Varieties and 
Character ; Various Methods of Treatment ; Results— Articular Affections ; In- 
troduction — Acute Inflammations of the Joints: Traumatic and Other Forms; 
Rheumatic Polyarthritis ; Chronic Inflammations of the Joints : 1. Monoarticu- 
lar Chronic Articular Rheumatism ; 2. Polyai-ticular Chronic Articular Rheuma- 
tism : 3. Arthritis Deformans; 4. Stiffness and Ankylosis of the Joints — Dis- 
eases of the Glandular Organs ; Tumors of the Lymphatic Glands— Scrofula — 
Splenic Tumors— Diseases of the Thoracic Viscera — Nervons Asthma — Nervous 
Palpitation of the Heart— Del)ility and Irregularity of the Heart pp. 327--885 



• 



OOTSTTENTB. Zl 



LBCTUBB XXXT. 



DbeaMB of the DigentiTe Oxgans : Neuroses of the (Esophagno—DiaeaseB of the Ston- 
aoh: Nerroufl y omiting ; Cardialgia; Nervotis Dyspepsia; Methods of Eleetrical 
Treatment; Atony and Dilatation of the Stomach— Diseases of the Intestines: 
Nervoos Enteropathy; Enteralgla; Atony aod Paralysis of the Muscular Coat 
of the Intestines: 1. Ocolnsion of the IntesUiies by Atonic Aoonmnlation of 
Fasces; Pathology; Cases; Methods of Electrical Treatment; Invagination of 
the Intestines ; 2. Chronic Constipation from Atony of the Intestines ; Cases ; 
Percntaneons Faradization ; Becto-abdominal Faradization ; Galvano-faradiza- 
tion; 8. Prolapsus Ani; Paresis of the Sphincter Ani; Ascites; its Faradio 
.Treatment pp. 836-344 



XIL DISEASES OF THE UBINABY AND SEXUAIj OBQANa 

LECTURE XXXVL 

Diseases of the Bladder. Introduction. Vesical Spasm ; Causal and Direct Treat- 
ment — Paralysis of the Bladder: Various Forms; Pathogenesis; Causal and 
Direct Treatment ; Percutaneous and Internal Applications ; (Galvanization of the 
Lumbar Cord — Nocturnal Enuresis : Its Nature ; Methods of Treatment — Diseases 
of the Male Sexual Organs : Inflammation and Hypertrophy of the Prostate ; 
Orchitis— Functional Disorders : Impotence ; Pollutions ; Spermatorrhoea ; Asper- 
matism ; Pathogenesis ; Causal and Direct Treatment — Diseases of the Female 
Sexual Organs — Introduction — Ovarian Hypenesthesia — ^Disturbances of Menstrua- 
tion: Amenorrhcea; Dysmenorrhoea ; Menorrhagia — Chronic Metritis — Changes 
in the Portion of the Uterus — Deficient Secretion of Milk — Concluding Remarks — 
Centra-indications to the Employment of Electrioity — Condition of the Circulatory 
Organs and Mode of Reaction of the Nervous System pp. 845-857 

INDEX pp. 859-d(MI 



EXPLANATION OF THE ABBREVIATIONS USED IN THE TESL 

An = Anode, positiye pole. 

Ca = Cathode, negatiye pole. 

CI = Closure. 

O = Opening. 

D= Duration, the period during which the oironit is dosed. 

= Contraction. 

Ca CI = Cathodal closure contraction. 

An O C = Anodal opening contraction. 

Ca CI Te = Cathodal closure tetanus = Ca D >, cathodal duratioa 
contraction. 

O B = Resistance to conduction. 

D N = Deflection of the needle. 

De B = Degeneration reaction. 



ELECTRO-THERAPEUTICS. 



PART I. 

PHYSICAL INTRODUCTION. 

LECTURE I. 

The Various Kinds of Guxrents — Contact Eleotrioity; the GkdTsnio Cnrxent — G«l- 
Tanio Circuits — Indaotion Electricity; the Faradio Current— The Ordinaij Ap« 
paratus and Auziliaiy Apparatus ; Induction Apparatus and Galvanic Batteries. 

I HAT assume without a doubt that you are acquainted with the doc- 
trine of the physics of electricity in all its main features. This, at all 
events, forms the only reliable foundation of electro-therapeutics, the 
basis for an assured employment of this therapeutic agent for diagnostic 
as well as therapeutic purposes. I cannot, therefore, recommend too 
strongly to you a careful attention to this subject and its frequent re- 
capitulation. If you desire to become good electro-therapeutists, you 
must completely master it, so far as it comes in question for our especial 
purposes. The attainment of this goal will be rendered considerably 
easier for you by the excellent little works of J. Rosenthal, Fick, Zech, 
y. Beetz, and de WatteviUe. 

At the same time I neither can nor will omit to give a short descrip- 
tion of those features which are absolutely necessary in order to under- 
stand what is to come hereafter ; but this can be nothing more than a 
rapid sketch, which you should fill in by independent study. 

As is well known, electricity appear^ in various modifications, which 
are dependent on the method of their production and on the arrangement 
of the current-producing apparatus. 

At the present time, we employ almost exclusively, for therapeutic 

purposes, the so-called electrical current. For a long time post, and even 

to-day, numerous therapeutic trials have been made with frictional elec- 

tricity, the so-called tension or static electricity, obtained from frictional 
1 



2 .•••.::■':.•■;•.." "feLaWifttTiiEKAPEUTics. 

electric machines and the scMwlled induction machines ; but these experi- 
ments — even the latest ones made in Paris— have furnished no very en- 
couraging results, and static electricity has still to conquer a secure place 
in electro-therapeutics. In the following disquisitioo we shall therefore 
not refer to this form of electricity — for which, however, the same laws, 
in general, hold good as for the electrical current. 

Electrical currents, as is well known, may he produced by veiy differ- 
ent aubstancea ; in electro-therapeutics we employ almost exclusively, at 
the present time : 1, galvanic currents produced by contact (constant, con- 
tiuuous lottery currents) ; and 2, the so-called faradic currents produced 
by induction (induced, interrupted, induction currents). The currents 
produced by the newer, powerful electrical machines, which are used 
chiefly for industrial puipoaaa, and which ar^ perhaps, destined to play a 



prominent part in electro-therapeutics, may be left unnoticed for the 
present. 

Contact Electricity. — The moBt simple scheme for the production of 
contact currents — entirely apart from the still unsettled physical theory 
of galvanism, concerning which we need not enter here further in detail — 
is the following : If two different metals (either copper and zinc, or carbon 
and zinc) in the shape of plates are placed parallel to one another, but 
without coming in contact, in a fluid, a solution of a salt or acid (as in Fig. 
1), a separation of the electricity in the metals wiU be produced by their 
contact with the fluid, so that all the positive electricity accumulates, 
under a certain tension, on the one metal, all the negative electricity on 
the other. 

This tension varies greatly, according to the quality of the metals and 
the fluid employed. The various metals can be arranged in a series (ten- 



PHYSICAL INTRODUCTION. 8 

non series), in which the one utuated at one end becomea most poaitiTely 
fllectrical from contact with a certain fluid, that at the other end moat in> 
tensel^r negatively electrical 

Such a simple combination —two metals in a fluid — is called an <^pen 
«hain, or an open, simple element. If the free ends of the metals are 
connected with one another by a conducting body, as a metal wire (Fig. 
2), the electrical tensions produced upon the two metals are equalized 
through this wire, which ia termed the " cirouit of cloanre," inasmuch as 
the electricity flowa from one metal to the other. We then have a closed 
element in which an electrical current ia flowing. 

The equaUzation of the tension does not cease with the closure of the 
«bain, but the contact of the metals with the fluid (or their chemical 
action upon one another) causes a continuance of the separation of the 
«lectricity, a constantly recurring tension, by means of which — so long aa 



Via. >— A onpoiind dwln. T)UH<ltin*nu>rTmnc«<t "bcblnd mttntkbt," TiM CInctlaa a( tb* nr- 
not li lodlsUsd bj U» tmwm. 

metals and fluid are still present— a constant flow of electricity ia pro- 
duced in the circuit of closure and throughout the entire chain. 

This power of permanently maintaining and constantly reproducing a 
certain difference in the electrical tension, is called the electro-motor 
power of such a combination. Its amount dependa alone upon the quality 
of the metals and fluids employed in the combination. In any individual 
case, the greater the difference of tension between the two metals, the 
greater ia the amount of electricity produced by the combination, and 
thus, also, ceteria paribua, the greater will be the strength of the current 
produced. 

If a number of these simple elements are placed alongside one another, 
and the metal of one connected with the differently named metal of the 
next (Fig. 3), the tensions produced in all the indiridua] elements will be 
aggregated, and the aum of tbeae tensions will appeur at the terminal 
points of such a compound chain. It produces a corresponding increase 



4 ZLECTBO-THERAPBUnca 

(rf &e strength ot the current in the "circuit of closure," which eonneots 
the free end of the metal of the last element, which has heoome positive, 
with that of the first element^ which has become negative. 

This form of connection of the elements is called an arrangement 
"behind one another." In the electro-therapeutics of internal diseases, 
we make exclusive use of such elements arranged " behind one another" 
(for reasons which will be made evident later), and these ma; be collected 
in any number desired into so-eaUed " batteries ; " we shall therefore, 
onoe for all, discuss such elements and batteries alone. 

In a compound element of this character, the "circuit of closure" 
puses from the fiiat to the last element ; the current flowing in it has a 
definite strength and direction, and 
natnrall; runs in an opposite diieo- 
tion in the element ilself from that 
in the " circuit of closure " — in the 
" circuit of closure " from the car- 
bon to the zinc, within the chain 
itself from the zinc to the carbon. 
It bos been agreed to coll that end 
of the element from which the posi- 
tive current passes into the " circuit 
' of closure," the positive pole or the 

anode, the opposite end, where the 
positive current again enters the 
chain, i.e., leaves the " circuit of 
closure," the negative pole, or cath- 
ode. 

Ton may now divide the "cir- 
cuit of closure" — imagined, in its 
aimplest form, as a simple conduot- 
in ing wire — and insert any other con- 
ductmg body between the two ends 
(fl. Pig. 4). The current will then pass through this conducting body, ac- 
cording to the laws which govern the latter. This is also true when the 
human body or individual parts of it are inserted in sudi a "circuit of 
closure." The points of entrance and exit of the current and its difiiision 
in the body then depend upon the situations at which both halves of the 
"circuit of closure "are applied, upon the resistance of the body, etc 
These factors all depend upon laws which I shall soon explain to you. 
That portion of the " circuit of closure " which conveys the positive cur- 
rent to the human body is called the positive pole or anode (An) ; the 
other part, by which the positive current escapes from the body, the nega- 
tive pole or cathode (Ca). The portions of the "circuit of cloanre " giving 
ingress and egress to the current, and which, for practical purposes, mar 



no. 4..— Scberniitlo npTf*fmt*tkm of 



PHYSICAL INTRODUCTION. 6 

be given rariouB fonns at the points of contact with the human body, are 
called electrodes. 

The essence of electro-therapeutics consists simply in the fact that the 
human body — either as a whole, or generally only certain parts of it—is 
introduced in a definite manner into the '* circuit of closure ** of a galvanic 
(or some other electrical) current ; in other words, the current is conveyed 
by means of the electrode to the body or its parts, and allowed to act 
upon it, with a certain intensity, for a variable period, with or without in- 
terruptions. It is very evident that an endless variety of applications 
may be produced in this manner, and that the art of the electro-therapeu- 
tist consists essentially in the choice of the proper method of application 
in an individual case of disease. 

The chief requisite of all galvanic elements employed for electro-thera- 
peutic purposes is that they should furnish a constant current of a 
strength corresponding to the relations of the human body as regards 
conduction, and which may be readily conveyed to the body by suitable 
electrodes. At a later period I will briefly refer to the other necessary 
auxiUary apparatus. 

Induction Electricity, — Under this term we may discuss the induction 
currents produced by magnets as well as by galvanic currents, since essen- 
tially they amount to the same thing. 

Electrical currents may be produced by the action of magnets upon 
closed conductors ; if a mi^^et is rapidly approximated to such a closed 
conductor — for example, a wire wound upon a cylinder, a wire spiral, the 
ends of which are connected with one another — an electrical current de- 
velops in the spiral during this approximation : if the magnet is rapidly 
removed, a current again develops in the spiral, but in the opposite direc- 
tion from the first. These currents are so much stronger, the stronger 
the magnet, the more rapid its approximation and removal, and the greater 
the number of turns in the wire spiral If the human body is introduced 
between both ends of the wire spiral, these currents will pass through the 
body and may thus be employed physiologically and therapeutically. 
Upon this principle depends the construction of the so-called magneto- 
electrical or rotation apparatus, in which, by a suitable arrangement, a 
magnet is very rapidly and frequently approximated and removed from a 
wire spiral, by means of which a large series of rapidly following currents 
develop, directed alternately in opposite directions ; these may exercise a 
very vigorous effect upon the human body. The rotatory apparatus have 
recently been displaced by the so-called induction apparatus, because 
their employment was attended with much inconvenience. I will there- 
fore spare you further details concerning tbeir construction. 

Perfectly analogous electrical currents may be produced with great 
readiness by galvanic currents, by means of induction.^ If a wire spiral, 
through which a galvanic current is following, is rapidly approximated to 



6 ELECTBO-TfiERAPEUTICS. 

a similar closed wire spiral, an electrical carrent develops in the latter dur- 
ing this approximation, and is directed in the opposite direction to that 
flowing through the former ; if the first spiral is now removed with equal 
rapidity, a current again develops in the second spiral, which now flows 
in the same direction as that in the first This is also the case when both 
spirals are fixed at a certain distance from one another ; and if a galvanic 
current now develops in the first — the primary — spiral, it is as if it were 
very rapidly brought from an infinite distance into close proximity, and 
an induced current will develop accordingly in the other — the secondary 
— spiral, and likewise when the galvanic current again disappears in the 
primary spiral. Such a rapid development and disappearance of the cur- 
rent can be produced readily by alternate opening and closiire of the 
primary current in the primary spiral. At each closure, a current de- 
velops in the secondary spiral in a direction opposite to the primary cur- 
rent ; at each opening a current develops in the same direction. These 
" induced *' currents are so much stronger, the stronger the primary cur- 
rent, the greater the number of turns in the primary as well as the second- 
ary spirals, and the closer both spirals are to one another — strongest, 
therefore, when one is pushed entirely over the other. 

If the opening and closure of the primary current follow rapidly and 
constantly, a continuous series of rapidly following currents alternately 
directed in opposite directions occur in the secondary spiral ; these are 
the so-called induced or induction currents, or faradic currents, as they 
are now called almost imiversally by electro-therapeutists. If the human 
body is inserted in the secondary spiral, these faradic currents will pass 
through the body, and can produce their physiological and therapeutical 
e£Eects. 

All currents produced in this manner have an extremely short dura- 
tion ; they are currents of almost momentary duration. The apparatus 
constructed in the most varied forms for their production are the so-called 
induction apparatus. Their ordinary construction gives rise to the cir- 
cumstance that the induced currents (of the secondary spiral) produced 
by the closure and opening of the primary current are of unequal strengths : 
the current developing during closure (closure induction current) is de- 
layed and weakened by an extra current (to which we shall refer again), 
developing at the same time in the primary spiral, while at the opening of 
the primary current this extra current does not develop usually, and con- 
sequently cannot modify the secondary opening induction current. The 
stronger opening current is always followed, therefore, by a weaker clos- 
ure current in the secondary spiral. The difference between both is quite 
considerable, as you can readily prove by holding both ends of the second- 
ary spiral in the hands, and making single openings and closures of the 
primary current ; at each opening you will experience a very severe shock, 
at each closure a very feeble shock or none. By a suitable arrangement 



PHYSICAL INTBODUOnOW. 7 

aj^lied to the apparatus, this difference may be almost entirely compen- 
sated ; usually this is not done in the apparatus employed for therapeuti- 
cal purposes. 

In the application of these currents to the human body, the opening 
current is so predominant that it may be taken into consideration almost 
exclusively, and we are thus justified, to a certain extent^ in determining 
the direction of the current, and choosing the name of the pole according 
to it. In the employment of secondary induction currents, we may indeed 
speak of the anode and cathode, inasmuch as we mean that this is true of 
the opening current alone ; but we should not forget that each electrode 
is alternately anode and cathode in rapid succession. 

The action of the induced current may be considerably intensified by 
combining with it the action of a magnet. If a soft iron rod or a bundle 
of iron wires be pushed into the primary cylinder, it becomes magnetic 
on closure of the current, demagnetized on opening it, and the induction 
effect, which corresponds to that of a magnet rapidly approaching from an 
infinite distance and disappearing with equal rapidity, is added to that of 
the primary coiL In the majority of our induction apparatus these soft 
iron wires are introduced therefore within the primary coil. 

In all these apparatus you will also find a small arrangement which 
automatically produces interruption (closure and opening) of the primary 
current, and which is conveyed from an external source — usually one or 
two galvanic elements — to the primary spiral ; the contact which secures 
the closure of the current is broken and restored with extremely rapid 
alternation, by means of an armature which is made to vibrate through the 
action of a magnet. The principle of this arrangement is always the 
same ; the method of its construction may be very different. 

I must here refer to another point, viz. : that in the primary spiral 
itself induction effects and currents develop, inasmuch as the individual 
coils of such a spiral produce induction in one another. The currents de- 
veloping on closure need not usually be considered, but, on the other 
hand, the induction current developing at the opening of the primary cur- 
rent may be readily detected by suitable mechanism, and employed for 
therapeutic purposes ; this is the so-called extra current. It is an induced 
cturent^ but develops in the primary spiral ; it is also called the primary 
faradic current, that developing in the secondary spiral being termed the 
secondary faradic current. 

The fundamental principle of the induction apparatus therefore con- 
sists in this, that by means of frequent interruptions of a galvanic current 
passing through the primary spiral, currents are induced in the secondary 
as well as in the primary spiral, and these may be conveyed to the human 
body by suitable arrangements. 

A gradation of the strength of these currents may be secured by push- 
ing one spiral over the other, by pushing in the soft iron wire, etc. It 



8 XLBOTBO-THBBAPSUnCS. 

■bould always be kept in mind in this connection that induced cnrrenti 
consist of a large number of currents of momentary duration, following 
one another in rapid succession ; entirely diffiBrent, therefore, from the 
gahranic current, which flows constantly in the same direction. 

In the consideration of the apparatus and accessory apparatus in 
common use, I shall merely give a short description, pertaining chiefly to 
the principles involved. I desire simply to formulate the demands which 
must be made upon the apparatus, and which can be fulfilled in various 
ways, and I will then describe, somewhat more closely, the most indispen- 
sable accessory apparatus. 

The first demand to be made upon an induction apparatus is that the 
spirals be sufficiently large to produce the necessary strength of current, 
and that the length and thickness of the wires in the primary and second- 
ary coils present a proper relation to one another. (It has always appeared 
to me that secondary coils of very thin wire are less suitable because they 
produce currents which are decidedly more painf uL ) Convenient arrange- 
ments for the conduction of the secondary and primary induction currents 
must be present, and the possibility of properly graduating the strength 
of the current Finally, the automatic interruptor should have a good 
and reliable movement ; the galvanic element necessary to work the in- 
strament must be sufficiently strong and constant, and the number of 
coils and the thickness of the wire in the primary spiral must be chosen 
correspondingly. 

For all scientific investigations, for exact work, for permanent appa- 
ratus in the home of the physician and specialist^ the well known Dubois- 
Beymond's sliding apparatus are best adapted. 

For other purposes, especially for outside practice, the so-called port- 
able induction apparatus are best suited. The coils may be placed either 
horizontally or vertically, are also provided with an arrangement to gradu- 
ate the current, not infrequently with scales, upon which these gradations 
can be read off. 

The industry of manufacturers and the inventive spirit of many electro- 
therapeutists have led to the construction, also, of numerous small, so- 
called pocket induction apparatus, which are characterized by small size 
and weight, usually by ready applicability ; they may be very useful in 
many cases in practice, but are not suited for more exact diagnostic and 
scientific investigations, and usually lose their power after prolonged use. 

In the construction of galvanic batteries all possible galvanic elements 
may be employed, provided they are well made and in good condition — 
from the older Daniell's, Grove's, Bunsen's elements to the newer ones of 
StOehrer, Siemens-Halske, Pincus, Leclanch6, Trouv6, Muirhead, Smee, 
etc. For practical purposes, with respect to cheapness and especially 
with reference to convenience, filling and cleaning the elements, it will 
naturally be necessary' for you to make a choice. 



PHYSICAL INTRODUCTION. 9 

To one point I cannot omit calling your attention at the present time, 
idz., that no great importance is to be attached, in practical electro-thera- 
peutics, to the greatest possible and absolute constancy of the element& 
The requirement of really constant elements, which is sometimes main- 
tained by '' exact " electro-therapeutists or brought into prominence by 
the instrument makers, is simply naive when compared with the real oir- 
eomstancea A constancy of the elements, such as is required in our ap- 
plications to each individual, lasting three, five, or at the most ten 
minutes, is secured even by the poorest construction ; and, on the other 
hand, even in the employment of the most constant elements during ordi- 
nary therapeutical appUcations to the living body, so many factors are 
introduced whidi cause variations in the strength of the current— for 
example, increasing conductivity of the epidermis and skin on account of 
the moisture of the latter ; duration of the current ; change of resist- 
ance from increased or diminished temperature, from the larger or 
smaller amount of fluid with which the electrodes are moistened ; change 
in the pressure with which they are appUed ; polarization at the elec- 
trodes, perhaps also within the tissues, etc. — that the supposed constancy 
of the cuiTent is purely illusory. The constancy of the elements is only 
important with reference to the duration and reliability of the battery as 
a whole, but it is not by any means a necessary requisite for our thera- 
peutical purposes and may be fully compensated by other advantages, 
presented by many inconstant elements. 

The most necessary qualities required in a galvanic battery by the 
practical physician are : cheapness, readiness of use and ease in keeping 
it in order, a certain durability of the elements, a sufficient number of 
the latter, the possibility of removing and reinserting them at any mo- 
ment, a suitable and easy method of introducing and employing any num- 
ber of elementa 

We now possess a large number of batteries composed of the most 
various elements (Stoehrer, Ledanch^, Siemens-Halske, Daniells, Trouv6, 
etc.) which leave scarcely anything to be desired. 

One difficulty still remains : a transportable battery which is readily 
conveyed without any inconvenience and at the same time remains in 
working order, so that the practitioner can carry it in his carriage, still 
remains to be constructed. Great progress has been made in this direc- 
tion, and there are now numerous batteries which are readily transport- 
able. But they still present many inconveniences. You will be told in 
one of the next lectures that the elements employed for therapeutical 
purposes in human beings may be as small as desired without losing their 
electro-motor power. But this small size nevertheless has its practical 
limits on account of the slight durability of many of these elements, the 
danger of rapid evaporation and the necessity of frequent renewal of the 
fluid, on account of the frequent change necessary in the metal of the ele- 



10 BLEOTRO-THSRAPEUnOS. 

mente, etc. It would, however, be very interesting to investigate whether 
elements of varying size but of the same construction, or elements of 
varying construction (Bunsen and Leclanch6, Daniell and Pincus), can 
produce different physiological and therapeutical effects. From a purdiy 
physical standpoint, this cannot be readily accepted, but the remarks and 
observations of some electro-therapeutists indicate such a possibility. 

So far as my observation goes, the batteries constructed by Stoehrer, 
and which have been subjected to innumerable imitations, appear to ma 
to be ihe most serviceable. For the specialist, for hospitals, etc., the 
large batteries of Siemens-HaLske or Leclanch6 elements, or even of Meid- 
inger elements, may be recommended, but they require thorough repair 
from time to time, and it is more difficult to keep them in order. 



LECTURE n. 

AooeoBOiy Apparatus : Selector or Element Numerator — Polarity Changer — Galvan- 
ometer —Measoremeut of the Ahsolute Strength of the Current— Rheostat — Con- 
ducting Wires — Electrodes and their Varioua Forma— Electrical Table.— Physical 
and Physiological Recognition of the Poles. 

The proper practical application of the apparatus above described re- 
quires a number of accessory apparatus, upon the proper construction of 
which depends in good part the ease and exactness of the application of 
the current for diagnostic and therapeutic purposes. 

Under the term selector, or better, element numerator (according to 
Zech) is meant a small apparatus which should not be absent in any gal- 
vanic battery and which enables us to include or exclude from the circuit * 
any number of elements desired — if possible without interruption of the 
closed current. This is effected by a number of contacts corresponding 
to the number of elements, and which may be connected with the con- 
ducting wires by the most yarious methods ; either by means of contact 
springs which are fixed to a sliding movement, to be moved to and fro 
(Stohrer), or to a revolving disc, and are so arranged that the last con- 
tact is not broken until the next has been reached ; or by means of 
two plugs, one of which is not removed until the other has already been 
placed in the next The most perfect selector is that which enables us to 
include one additional element at a time in the circuit ; this is frequently 
only possible for the smaller number of elements, for the larger ones each * 
three, five, or ten elements. 

A very important accessory apparatus, which is indispensable for aU 
more exact investigations, is the polarity changer. This little apparatus is 
introduced into the circuit for the purpose of changing the direction of 
the current at pleasure. It must also be so arranged that it permits sim- 
ple opening and closure of the current in any direction of the latter, and 
also reversal of the direction of the current with readiness. The very 
practical polarity changer, which is now in almost general use, has the 
construction shown schematically in Fig. 5. 

Upon the periphery of a movable gutta-percha disc two metal strips 
are fastened in such a manner that a distance of 1 to 1^ ctm. is left between 
their free ends. Four metallic contacts conduct the current to and fro ; 
1 and 2 are connected with the battery (Anode +, Cathode ~), 3 and 4 con- 



12 , BLB0TB0-THEBAPBDTI08. 

vey the current farther throogh the circait. The met&l atrips mentioned 
secure the connection between two contacts — In pomtion L, between 1 and 
3 on the one hand, and 2 and 4 on the other. In this position of the 
disc, which is revolved by the lever a, the current passes from 1 to 3, and 
3 is therefore the anode ; it returns from the circuit, from the human 
body, to 4 and then passes to 2 ; 4 is therefore the cathode ; the current 
passes in the circuit of closure from 3 to 1. 

If the lever a is turned a quarter of a circle so that it assumes poaitioD 
nL, you will see that this direction is reversed ; contact 1 is now con- 
nected with 4, contact 2 with 3 ; i has become the anode, 3 the cathode ; 
the current passes in the circuit of closure and the body from 4 to 3 ; yoa 
have thus produced a " reversal of the direction of the current," 

If the lever a ia only turned 45°, so that it assumes poBition IL, two of 
the contact springs touch the free space between the two metal atripa, i.e^ 

I n to. 



mm ia KcordiJiffl^ Tt 



se diffenni pndtlon* at U» b 



the current is open. You may then, at pleasure, close it in one or the 
other direction and again open it, without reversiiig the current ; yon may 
at will convert each of the contacts 3 and 4 into the anode or the cathode, 
and if the electrodes in connection with them are applied to a certain part 
of the body, you may there secure the action of the cathode or the anode, 
make a cathodal closure and opening, or an nnodal closure and opening. 
Or you may, at the same locality, reverse from the anode to the cathode or 
vice versa. 

Brenner's modification coneints in the introduction of an intervening 
piece, which filial the free space between the two metnl strips with the ex- 
ception of a small slit, and thus permits very rapid reversal of the current, 
which is requisite for many diagnostic purposes. 

The polarity changer is an indispensable apparatus for exact electricaj 



PHTSIOAL IKTBODUCnOK. 13 

examination^ for the making of repeated closures and openings of the cur- 
rent in both directions, and for reversals of the current In many bai> 
teries jou will still find polarity changers which merely permit reversal of 
the current, but not simple opening and closure of the current ; these are 
worthless or, at least absolutely useless for electro-diagnostic examinations. 

A good galvanometer is no less indispensable for all accurate investiga- 
tions and, I may also add, for the ordinary operations of electro-therapeu- 
tics. Formerly it was only employed to indicate that the current was 
really passing. More recently it has been recognized that the galvan- 
ometer is very useful and even necessary in measuring the strength of the 
current which really comes into play, in diagnostic examinations as well as 
in the therapeutical applicationa I was the first to declare it incontro- 
vertible that, in quantitative electrical examinations of irritability, the de- 
termination of the strength of the current employed can be made by 
means of the galvanometer alone, as its determination in the manner for- 
meriy in vogue, according to the number of elements employed or the re- 
sistance of the rheostat introduced into the circuit, is entirely insufficient 
and faulty. At my suggestion Hirschmann in Berlin has constructed a 
galvanometer (a vertical galvanometer, according to the principle of the 
multiplicator) which meets all ordinary requirements, possesses four grades 
of sensitiveness, and thus permits measurement of the most varying 
strengths of the current and is very useful in diagnostic examinations. 
This has been very generally accepted, but it possesses the disadvantage 
that the figures found by its means can only be compared with each other 
in each individual instrument, since the movements of the needle vaiy 
greatly according to the sensitiveness of the instrument In addition, the 
strength of the current is only proportional to the angle of deflection when 
the latter is small, while the strength of the current increases much more 
rapidly than the angle of deflection when this is great. 

The attempt has been made recently to construct a galvanometer which 
will indicate the absolute strength of the current These galvanometers 
are graduated empirically in such a manner that the strength of the cur- 
rent is expressed in definite, generally accepted units, so that we can sim- 
ply read oflf : this is a current of six, or ten, or twenty, or twenty-five " units 
of the strength of the current" On account of the increasing resistance 
with the increased deflection of the needle, it is evident that the divisions 
of the scale must gradually come in closer proximity. At present authors 
are still at variance with regard to the unit of strength to be accepted — 
whether the ** milliveber " proposed in England, or the units employed in 
Germany, and which diflfer slightly from the English. 

The adoption of the same scale would be attended with very great ad- 
vantages ; we would then be able to express the strength of the current 
in simple numbers (for example, a current of five, ten, twenty millivebers, 
etc.), to mention accurately the strength of the current in examining the 



14 ELEOTRO-THEBAPBUnCS. 

irritability of nerreHstructures, to compare the statements of others with 
our own figures, to control accurately the strength of the current in thera- 
peutics, and thus regulate the dose of electricity as of all other medicinal 
agenta 

Easy as this may appear to some, there are still many technical diffi- 
culties which must be overcome in the construction of such galvanometera 
A physiological obstacle to the general applicability of absolute measures 
of the strength of the electrical current appears to me to be much more 
important ; this is the significance of the density of the current, which is 
•entirely independent of its absolute strength, with regard to its physio- 
logical and therapeutical action. Every experienced electro-therapeutist 
knows that the effect of a definite strength of current, if the electrode ap- 
plied to the nerve has a surface of contact of one square centimetre, is 
•entirely different from that produced if the surface of contact measures 
twenty square centimetres. The most exact statements must be made 
with regard to the method of application, the form and size of the elec- 
trodes, and their exact points of application, or the statement of the abso- 
lute strength of the current will have no value. 

Numerous attempts have been made to introduce the so-called rheostat 
into electro-therapeutics, in order to make a delicate and imiform gradation 
'Of the strength of the current in the circuit The attempt was made to at- 
tain this end, partly by introducing graduated resistances into the circuit, 
— usually columns of fluid such as water, solutions of salt, and the like 
(fluid rheostats) — ^partly by introducing into the auxiliary circuit of the 
main circuit variable resistances, with the increase in which the strength 
of the current in the circuit increases, with whose diminution the strength 
of current in the main circuit diminishes (Brenner's rheostat). All these 
instruments fulfil their purpose in a very defective manner. The fluid 
rheostats soon become imcertain on accoimt of electrolysis and polariza- 
tion, usually act promptly only when the number of elements is small, and 
are to be recommended at the most in those cases in which we wish to 
change the strength of the current very gradually. The fluid rheostats 
constructed by Stohrer according to Hinge's suggestions are very practical ; 
they are filled with a 40 per cent, solution of sulphate of zinc, with amal- 
gamated zinc electrodes. These are simple, cheap, and practically useful 

It appears to me, however, that much praise cannot be bestowed upon 
any form of rheostat, and that our accessory apparatus for the delicate 
and uniform gradation of the strength of the current still require very 
much improvement. 

The so-called conducting wires serve to convey the current from the 
polarity changer to the electrodes. They must be as thin and flexible as 
possible, not unroll nor easily break, and be about 1.5 to 2 m. long. They 
are best made of very fine, loosely rolled silver or copper wires, or of 
woollen or silk threads surrounded by metal They must be well insu- 



PHYSIOAI. INTBODDOnOH. ' 



IS 



lated, best by thin robber tubes, in order to prevent their becoming 
moiat and thus allowing the posaibility of unintended accessory dosures. 
Zt is especially important that their conaection with the clamps of the 
polarity changer and the electrodes be as solid and secure as possible. 

For diagnostio and therapeutic purposes the current is conveyed to 
the human body by means of electrodes. Very much depends upon their 
size, fono, and construction ; we still find very unpractical electrodes, 
which are absolutely insufQcient for many purposes. The choice depends 
entirely upon the purposes which we desire to attain, and is regulated 
simply by the physical laws which we will discuss in the next lecture. 

Metallic electrodes (of brass, preferably well nickel plated) are the 




most useful, but those made of carbon may also be employed. The eleC' 
trodes may be button-shaped or flat ; the former are best covered with a 
moderately thick layer of fine spoDge, the fiat ones with soft fiannel sur- 
rounded by a layer of fine linen. Flat electrodes may be square or round ; 
they should be somewhat bent at the edges and angles or have a concave 
surface, especially the lai^er forma. Chief attention must be paid to the 
fact that the covering is not worn at the edges, so that the metal cornea 
througL 

The size of the electrodes varies greatly according to the use to which 
they are to be put ; for the most careful localization of the current upon 
individual points, fine branches of nerves, motor points of muscles, etc, 
we employ button-shaped electrodes, the diameter of whose sponge cover- 



16 



XLIOTBO-TBSBAFEUTKB. 



ing M not more ihm | etm. I shall hereafter call these ^ fine '* or ' 
est" electrodes (Fig. 6, a). The next laiger form, for the stimiilmtian of 
muscles and larger ner?e4rank8» for the i4>plication of the corrent to the 
eye, face, neck, may have a sponge coTering with a diameter of 1^ to 2 otm. 
diameter, and ibey will be called by me " smaU " electrodes (Fig. 6, b). 
Then comes the flat electrode, which is preferably employed by me lor aU 
applications of the galvanic corrent to the iace or neck, for local galvanic 
stimulation of the nenres and muscles, for quantttatiye examination of gal- 
iranic irritability ; this is a square plate, the sides of which are 4 to 6 etm. 



rp 



m^ 





/ 



FM.T. 



♦•!m««* H«H-trortP (10-t« ctm. lonir. 6-6 otm. wide); o', the mxom shown 
h«iiUl«. to >ft hlch all tUvtrodt^ c«n b« korvwwl. c. el«otrio«l brnah. 



. », 



lonpr* ^«d which I call the " medium " electrode (Pig. 6, c). Finally, the 
'* lar}^ " el<H^tix>ile, to l>e employed iu all applications to the back in dis* 
f4u»es of the spinal ci^ni in soiation, in affections of the large joints, and as 
an iniUrtVrcnt eltvtnvle ; it is a rectauomlar plate, concave on the free sur- 
faot\ tlu^ sivles In injY 5 to (1 ctra. and 10 to 12 ctm. long (Fig. 7, a and o). 
Still larj^t^r ohvtnvlea, '^rery lan^e" ones* will n\rely be necessary, but I 
haw ixvHJiionally eniplovcd such in rerv fat |x»r8ona or for special purposes. 
In jral\*Hni.-ins? tho hniin for >*:inous aisoj^sos I have recently employed 
Univ, plit^shi^H^^ ohctnxlts nho sivlt s Wii^or 14 to 17 ctm. lon<?), accu- 
nacl>^- bent aovxmUniC to the cune of the tikuU ; these are covered with a 



PHYSICAL INTBODUOnON. 



17 



thick, soft layer of sponge, can therefore be well adapted, and appear 
to me very serviceable ; I will call them *' large head electrodes " (Fig. 8). 

The majority of these forms of electrodes may also be made of com- 
pressed gas carbon, but they present no noteworUiy advantages, and the 
large ones are unpractical on account of their thickness and inflexibility. 

The electrodes must be screwed upon good strong handles ; the form 
and size of the latter depend mainly on habit and personal preferences of 
the electro-therapeutist. I find the strong and large ones (Fig. 7, b) most 
serviceable. For many examinations it is very useful to have handles 
which are furnished vdth an interrupting apparatus, so that the cxurent 
may be opened and closed during the fixation of the electrode by the pres- 
sure of the finger. 

In their application to the body, the electrodes must always be thor- 
oughly moistened, because otherwise they will not conduct the current ; 




Ite. &--**La«s»haAd ti6etrod«,**dd« Ttoir (14 otm. long, Total. wld«). Flozibla, nukde of 

ered with thick, soft ipoDgo. 



metel. Oor- 



the unmoistened epidermis is also an extremely poor conductor. The 
moistening is best done with very warm water. Cold water is a much 
poorer conductor, moistens the epidermis much more slowly and vnth 
more difficulty, and is usually very uncomfortable to the patient. Salt 
water, though it conducts much better, has so many inconveniences (de- 
struction of the electrodes by electrolysis, more marked burning of the 
skin, production of stains on the clothes, etc.) that I have long discarded 
it. At the most I employ it in those cases in which, on account of unusu- 
ally great resistance, the strength of the battery is insufficient to produce 
the desired effects. 

Hitzig has also employed and recommended " unpolarizable " electrodes 
for electro-therapeutic purposes. They are said to have the special advan- 
tage of being but slightly painful. But as their advantages are by far 
counterbalanced by the difficulty in handling these electrodes and keeping 

them in order, they have not secured a foothold in practice. 
2 



1 & ELBOTBO-THBBAPEUTIOB. 

Apart from those mentioned yoa will osuallj need a series of otber 
electrodes for certain c|>ecial purposes ; thus, especially, a dry metallic 
electrode, then one made of numerous fine metallic threads in the form of 
a brush (electrical brush. Fig. 7, c), then special electrodes for the treatment 
of the urethra, bladder, uterus, rectum, pharynx and larynx, recently even 
the stomach, etc. These consist of polished metallic buttons fastened to 
a long metallic staff, covered with rubber and of varying thickness, accord- 
ing to the object in view. 

This is about all the apparatus which you will need in order to fulfil 
all the practical and even the majority of the scientific purposes of elec- 
tro-therapeutica As a matter of course, it is useful to have all these appa- 
ratus arranged in a convenient manner, and so-called electrical tables have 
therefore been constructed, usually in a very elegant form. 

But these are by no means absolutely necessary; I have never 
possessed one and have always helped myself in a much more simple 
manner. 

Before leaving this subject, allow me to make a few remarks concern- 
ing the determination of the pole which is desirable when we cannot trace 
directly the connections from the An and Ca of the battery to the con- 
necting wires. This is done most simply by means of the electrolysis of 
iodide of potassium. Some starch-paste is mixed with a solution of iodide 
of potassium and the pole wires are placed in it; the iodine which is 
set free will produce an intense blue color at the anode. This test is 
usually insufficient for the faradic current ; the electrolysis is only dis- 
tinct when the intensity of the current is enormous, or it must be made 
more distinct by special methods (single opening currents, passage of 
sparks). The recognition of the poles by the different physiological 
efibcts, is as certain as their electrolytic determination. The cathode, if 
applied to a motor nerve, produces a much stronger muscular contraction 
on making the current than the anode ; if both poles are applied to the 
cheeks, the anode will produce a much 8ti*onger and distinct gustatory sen- 
sation in the tongue than the cathode ; many electro-therapeutists can 
clearly distinguish the two poles by the quality and color of the flashes of 
light on galvanizing the eye. You see, then, that we have, at any moment, 
sufficient means to distinguish the two poles from one another. The 
cathode of the faradic current (the opening current) may also be readily 
recognized by its greater irritative effects on motor and sensory nervea 



LECTURE m. 

Plijaioal Laws of the Diifasion of the Oarrent and their AppUoation in Electro-then^ 
pentioe^Ohm't Law — Strength of Cnrrent — ReeiBtance of Various Condnctors : 
Besistanoe of the A"''"'*^^ Tissaes, eepedallj the Epidermic — Individoal Differ- 
enoes in Bfan and their Oonsequenoes — Essential and Extra-essential Besistanoe ; 
Conolosions therefrom Gonoeming the Constmotion of Apparatus— Density of the 
Current and ltd Laws— Practical Deductions for Various Electro-therapeutical 
Purposes— Eleotroljtio and Cataphoric Effects. 

In the very large majority of cases it is the expressed desire of the 
electro-therapeutist to allow tlie electrical current to act upon certain 
parts of the body, viz., the diseased parts, with a certain strength, density, 
and direction, or predominantly with one of the two poles. 

You have become acquainted in the previous lectures with the source of 
the current and the apparatus employed for conveying it conveniently to 
the body. To-day we must examine how the current can be introduced 
into the human body, how it can be localized in certain parts in the 
manner desired. For this purpose, it is necessary that we again recall to 
mind the laws of the distribution of the current in various conducting 
parts. The human body is nothing more than a large conducting mass 
of definite resistance ; and the laws controlling the distribution of large 
conducting masses therefore apply to it without any limitation. 

These are the well-known Ohm's laws, and their accurate knowledge is 
of the greatest importance to the electro-therapeutist. Only by constantly 
bearing them in mind and utilizing them in a rational manner will you be 
enabled to apply the current rationally and scientifically. I know of noth- 
ing in physics which is of more importanae to the electro-therapeutist 
that an accurate knowledge of these very laws. 

1. The strength of the current (intensity = I) is in the first place depend- 
ent upon the electro-motor power (E) of the combinations employed in 
its production, of the metals and fluids employed in the circuit, of the 
position of the metals employed in the tension series, of the strength of 
the inducing magnet or the inducing current, of the number of coils in 
the cylinders, etc. If all the other conditions are alike, especially the 
circuit of closure and the external shape of the individual combinations, 
the strength of the current is directly proportional to the electro-motor potver 
af one coiqplet or other source of electrieUy. 



20 ELECTRO-THERAPEUTICS. 

It follows that yarious elements and combinations may have a different 
▼alue and that, in choosing them, consideration must be paid to their 
Taiying electro-motor power. If we wish to obtain a certain strength of 
current — and this must be comparatively great in electro-therapeutics — we 
must choose elements of relatively great electro motor power, induction 
apparatus of a certain size whose coils have a sufficiently large number of 
turns. 

2. You will at once discover, however, that although the electro-motor 
power remains the same, the quality of the circuit of closure has a very 
decided effect on the strength of the current. (I presume, as a matter of 
course, that you employ one of the accessory apparatus furnished by 
physics in measuring the strength of the current.) The circuit of closure 
introduces a certain resistance (= R) to the passage of the current. 
Circuits of closure of various constructions produce different resistances, 
and changes in the strength of the current will ensue according to the 
variations in these resistances. The following law formulates this rela- 
tion : the strength of the current is inversely proportional to the resi^ance in 
the closed chain. 

From a combination of this law with that previously laid down, it 
follows directly that the expression of the strength of current of a dosed 
combination is the following : the strength of current is equal to the eleo- 

E 

tro-motor power divided by the resistance, or I = = 

XV. 

This statement is of no small practical importance, since we have to 
deal in the human body — as you will soon learn — with enormous resist- 
ance to conduction, and we must therefore choose, for electro-therapeutic 
purposes, combinations of relatively large electro-motor power, though 
even then we will only obtain currents of relatively little strength. 

3. Further examination will teach you that not alone the qualily of 
the conductor in the circuit of closure will affect the resistance which it 
presents, but also the form of the conductor. Thus, a certain weight of 
metal, when it assumes the form of a short, thick cylinder, presents an 
entirely different resistance to the current from that presented when the 
metal has the shape of a long wire. It has been found that the resintance 
of a conductor is directly proportionate to its lengthy and is inversely pro- 
portionate to its transverse section. 

It therefore follows that the strength of current diminishes with in- 
creasing length of the conductor, but increases with its increasing trans- 
verse section. Cceteris paribus the current will be so much stronger the 
shorter and thicker the circuit of closure, and so much weaker the longer 
and thinner it is. 

These laws lead to certain deductions with regard to electro-thera- 
peutics, which we will consider somewhat more in detail. 

Various conductors present very different resistances to the current 



PHYSICAL INTRODUCmON. 21 

The metals are the best conductors ; pure silver affords the least re- 
sistance, then follow copper, gold, zinc, iron, etc.; mercuiy presents the 
greatest resistance, about fifty times as great as that of silver (both are 
employed as units of resistance).' 

Much greater resistance is presented by the various conducting fluids, 
such as solutions of salts, diluted acids, etc. ; they present 10,000 to 300,000 
times as much resistance as mercury. Pure distilled water is the poorest 
of all these conductors (about one hundred and twenty million times as 
great as that of mercury, Zech), but a slight addition of salts or acids in- 
creases very markedly its conductivity. 

Animal tissues are also poor conductors ; they may be regarded in 
general as solutions of salts of various concentration, and their conductivity 
depends in great part upon the blood circulating through them and upon 
the parenchymatous fluids. The many attempts made to determine the 
resistance of conduction (C E) of the different tissues have led to various 
results, but it seems that they do not present any very great differences in 
this respect, though muscular tissue is the best and bone the poorest con- 
ductor. It should also be mentioned that the transverse resistance of the 
nerves (when the current is directed transversely across them) is five 
times greater, and that of the muscles about nine times greater than their 
longitudinal resistance. It seems, then, that the conductivity does not de- 
pend solely upon moisture with solutions of salts ; it is, at all events, con- 
siderably diminished by the internal polarization which immediately occura 

In electro-therapeutics, however, we do not have to deal, as a rule, with 
the exposed animal tissues, but with parts which are covered by the exter- 
nal skin and with its homy layer, the epidermis ; this is a circumstance 
of the greatest importance, which is too often very little considered. In 
all ordinary applications of the electrical current to the hiunan body the 
main resistance is offered by the epidermis. In comparison with this re- 
sistance, all others need scarcely be considered ; at all events, the epider* 
mis is decisive with regard to the general strength of the current, though 
not with regard to the distribution of the current within the body. 

The epidermis consists of the mucous and homy layers. The former, 
consisting of soft, cellular elements, will present approximately the same 
resistance as the other animal tissues. This is different with regard to 
the homy layer, consisting of dry, vitreous cells ; this layer may be re- 
garded as non-conducting, offering a very great or absolute resistance to 
the current, as you can readily demonstrate upon the thick horny layers 
of the heels and soles of the feet or upon callous hands. Thorough moist- 
ening with warm water or a solution of salt is alone capable of restoring 
the conductivity of this homy epidermis. 



* The Siemens unit, which is the one most in nse, is equal to the resistance of a 
oolnmn of meroury 1 sq. mm. in transverse section and 1 m. in length. 



32 SLEOTRO-THEBAPEUnCS. 

If the homy layer covered the entire surface of the body in a uniform 
manner, it would indeed augur ill for the ordinary percutaneous applica- 
tion of electricity ; at all events, the apparatus at present in use would be 
insufficient But, entirely apart from the microscopical interstices be- 
tween the individual histological constituents of the homy layer, it is also 
perforated by a large number of more or less closely approximated open- 
iiigs, by the excretory ducts of the sebaceous and sudariparous glands 
and by the hair-follides, therefore by canals, which are everywhere cov- 
ered and permeated by a fluid containing salts ; it thus affords the current 
ready entrance to the deeper layers of the cutis, and in this manner to the 
interior of the body. The resistance of the epidermis to conduction un- 
doubtedly depends chiefly upon these fine passages for the current, upon 
their number and their more or less close approximation. 

The variations in the thickness and moisture of the epidermis, and in 
the quantity of hair-follicles and glandular excretory ducts are entirely 
sufficient to explain the fact that the epidermis presents a varying resist- 
ance to the ciirrent in different parts of the body, and also that very great 
differences in resistance are observed in different individuals upon corre- 
sponding parts of the body. 

Sex and age, race, and habits of life have great influence in this re- 
spect ; bare portions of skin act differently than covered ones ; parts fre- 
quently subject to pressure act differently than those which are prote<^ 
ed, etc. 

The following figures will serve as examples to illustrate the individual 
and local differences in the resistance of the integument to conduction. 

If the same electrodes, with the same amount of moisture and an eqtuil 
duration of the current, with the same introduction of the galvanometer 
and constant number of elements, be applied successively to various sym- 
metrical parts of the body, you will obtain, for example, at the following 
parts of the body the deflections of the needle here indicated : 

On both temples 40** 

** cheeks 60** 

" lateral surfaces of the neck 85** 

" scapulsB 20** 

" loins 5** 

•* anterior surfaces of the thighs 8® 

•* popliteal spaces 26" 

" external surfaces of the legs 2** 

•* anterior surfaces of the arm 25** 

" external surfaces of the forearm 22 

" palms of the hands 20 

Similar relations will be found in all individuals. The differences of C R 
(Besistance to Conduction) at similar parts of the skin in different indi- 






PHYSICAL INTRODUCnOir, 88 

viduals are often still more striking. In ten healthj jonng men, I hare 
found the following deflections of the needle with a precisely similar 
method of appHoation (An on the sternum, Ca upon the ulnar nerve of 
the right arm) : 

10^ 18°, 9°, r, 6^ 16% 6% 16% 4°, 8°. 

In two young girls, the application of the An to the small of the back, 
the Ca to the neck with a current of ten elements, produced in one 33^ 
deflection of the needle, in the other a deflection of 5° (in the latter, 18 
elements were required to produce a deflection of 33**). 

In two men suffering from lead palsy, whom I examined at the same 
time, two series of experiments showed the following considerable differ* 
ences : 

Experiment L — ^An upon the sternum, Ca upon the left deltoid : 

Case A Case B. 

(Aged 44 years). (Aged 26 yean). 

With 6 elements, 31° N. D 4° N. D. 

" 4 « 26° " 2° " 

«« 2 " 16° " ..!!!!!. ! 0° " 

ExFEBiMEMT 11. — ^Au upou the sternum, Ca upon the right radial nerre : 

Case A. Case B. 

With 6 elements, 29° N. D 7° N. D. 

" 4 " 24° " 3° " 

" 2 " 14° " i° " 

There may thus be enormous differences, and I might multiply these 
examples much further. 

The resistance to conduction also undergoes considerable changes upon 
the same part of the integument of one individual, on account of the in- 
creasing effect of the current, the increased moisture, greater congestion 
of the skin, etc. 

This is extremely important in making quantitative tests of irritability 
and may be readily demonstrated at any moment. Although the elec- 
trodes remain in one position, the deflection of the needle noted in the 
beginning becomes greater with the duration of the action of the cur- 
rent, the number of elements remaining the same ; it increases with 
every renewed closure of the current, still more upon every change of 
polarity, and remains finally at a much higher figure than at the beginning 
of the experiment. The diminution in the resistance becomes still more 
striking, if we allow successively stronger currents to act and then return 
to lesser strengths of current. The intimate causes of this diminution of 
the resistance to conduction on account of the action of the current itself 



24 ELECTRO-THEBAPEDTICS. 

are not yet entirely apparent ; we may think of the cataphoric action of 
the current, of changes in polarization, but especially of the action of the 
current on the blood-vessels of the skin, their dilatation and the greater 
permeation of the skin with fluid produced in this manner, especially in 
the vicinity of the hair follicles, sudoriparous glands, etc. (E. Kemak). 
To this cause probably is due also the fact that, for example, the applica- 
tion of a mustard poultice considerably diminishes the resistance of the 
integument to conduction. 

You will be frequently astonished to find how great a resistance to 
conduction the integument of children presents; this holds good to a 
still greater extent with reference to old age ; the C B of the skin in old 
people is often extraordinarily large, so that, for example, you may with- 
out any risk employ a number of elements even upon the head, which can 
not be tolerated at all by the most vigorous young people. You will find, 
by means of the galvanometer, that this " tolerance " or " brain torjwr " re- 
duces itself, as a rule, to a very much increased C K of the skin. Thus, 
in one man aged seventy years I was compelled to employ 24 Stohrer's 
elements (the battery being in good working order) in order to obtain a 
Bufficient strength of current (30° to 35° deflection of the needle). 

Hence follows the stringent rule that toe should form an opinion, by 
means of a few preliminary trials with the galvanometer, concerning the C R 
of tlie skin in each individual whom we wish to examine or treat. 

In comparison with the resistance of the epidermis, the length of the 
lK)rtion of the human body included in the circuit need scarcely be con- 
Hidered, or not at alL However great this length may be, it does not much 
nflect the strength of the current ; this depends solely on the condition of 
the epidermis at the points of application of the electrodes. It is a very 
striking fact in this connection that upon applying the electrodes to the 
neck and the popliteal space, the current is very much stronger than if 
the electrodes are placed at a distance of 10 to 15 ctm. upon both scapulsB 
or the lumbar region. 

This is shown by the following experiment : 

A healthy man of middle age ; two " medium " electrodes, A and B, are 
placed in various positions ; a current of ten elements is closed until the 
needle comes to rest, then change of polarity made and a second reading 
of the deflection of the needle, galvanometer 150 C B. 

• 

1. Electrode A in the neck, B in the popliteal space, at a distance of 
100 ctm. : 

Deflection of needle during first direction of current 19°. 
Deflection of needle after change of polarity 24°. 

2. Electrode A on right, B on left lumbar muscles, at a distance ol 
10 otm. : 

Deflection of needle during fii-st direction of current 10°. 
Deflection of needle after change of polarity 15°. 



PHYSICAL INTRODUCTION. 25 

3. Electrode A upon sternum, B on inner surface of forearm, at a dis- 
tance of 50 ctm. : 

Deflection of needle during first direction of current 2**. 
Deflection of needle after change of polarity S"", 

4. Mectrodes A and B upon inner sur^ce of forearm, at a clistanoe of 
5 ctm. : 

Deflection of needle during first direction of current ^®. 
Deflection of needle after change of polarity 2^. 

In the ordinary application of the current to the human body, therefore, 
its strength depends mainly on the resistance of the epidermis ; everything 
else is subordinate. And as the length of this conductor (i,e., the thickness 
of the epidermis) nowhere presents any considerable differences, it follows 
that the area of the latter is alone decisive with regard to the strength of 
the current to be attained in the body ; i.e., the extent of the epidermis 
which serves for the introduction of the current into the body — in other 
words, the size of the electrodes applied to the skin determines in the 
main the strength of the current. What occurs beneath the epidermis is 
quite immaterial 

It therefore follows that, other things being equal, the electrodes must 
be so much larger, the greater the strength of the current which we wish 
to introduce into the body ; this can be readily shown by means of the 
galvanometer on applying electrodes of various sizea 

As a matter of course, however, the size of the electrodes which may 
be employed also has its limits. The attempt has been made to render 
us independent, to a certain extent, of the size of the metallic or carbon 
electrodes by placing underneath them moistened layers of blotting-paper, 
by means of which the introduction of the current is to be obtained 
through a large surface of the epidermis. But this method does not prove 
very serviceable in practice. 

4. As a matter of course the current in a closed circuit passes not 
alone through the circuit of closure, but also through the element itself, 
its metals and fluids, and, according to its constitution, naturally meets 
here with a certain resistance. This resistance, which is situated in the 
chain itself and caused bv its construction, is called the essential resist- 
ance, while that met with in the circuit of closure is called the extra-es- 
sential resistance. Both are merely parts of the general resistance present 
in the closed chain and are subject to the same laws. It is therefore also 
true of the "essential " resistance that it increases with increasing length 
and diminishes with the increasing diameter of the conductor through 
which it passes ; or, in other words, the further the two metals in the fluid 
are separated from one another— the longer therefore the passage through 
the fluid from one meta] to the other —the greater is the resistance (and 
the weaker the current) ; and the larger the surface of the metal and the 
deeper the metals are immersed in the fluid, i.e., the greater the area of 



26 BLE0TB0-TH£BAPEnn08. 

the layers of fluid which most be passed through, the smaller will be tfaa 

resistance (and the stronger the current). The essential resistance also, 

therefore, influences the strength of the current, and the previouslj man- 

E 
tioned formula should therefore read : I = .=i= in which W is the omomk 

tial and w the extra-essential resistanoe. 

The strength of the current may then be afiected by a change in three 
factors, the electro-motor power, the essential, and the extra-essential re- 
sistance. The factor which is unchangeable so far as our purposes are 
concerned, is the extra-essential resistance (the human body and its ports 
in the circuit of closure) ; in order to change the strength of current in 
the circuit of closure we must change one of the other two factors, either 
increase or diminish the electro-motor power or the essential resistanee. 
A simple consideration will show that, under certain circnmstanoee, we 
may only do one or the other, that both are not suitable for all oasea. 

For electro-therapeutical purposes we practically work under two rerj 
different conditions : in the ordinary percutaneous application of electrictfy 
the circuit of closure contains the human body, which presents an enor- 
mous resistance, very much greater than the resistance in the chain itself ; 
the extra-essential resistance is here much greater than the essential 

In galyano-caustic applications, on the other hand, the circuit of doeore 
is formed by a good conductor, a metallic wire, and this presents a much 
less resistance than that present in the chain itself ; here the extra-essen- 
tial resistance is much smaller than the essential The latter event does 
not concern us here ; but the mere mention of the fact shows that in the 
first case a change of the essential resistance remains without any appreci- 
able effect upon the strength of the current, while in the second case, 
with a small extra-essential resistance, the essential resistance is almost 
solely decisive with regard to the strength of the current^ and therefore 
changes in it must modify the latter. 

It can be readily shown with regard to the first case that if, for ex- 
ample, we wish to increase the strength of the current, we cannot do this by 
diminishing the essential resistance (enlargement or deeper immersion of the 
metals, closer approximation to one another, etc.), but only by the addition 
of new electro-motor power, i.e,, by an increase in the number of dements. 

For our case, viz. : the percutaneous application of the current, we wUI 
assume that the essential resistance is 8, tlie extra-essential 200, then — 

Ell 

for one element I = ^^^^-^ = g-p^^o = 208 ' 

2E 2 2 1 

for two elements I = ^^^.— = jg^^^g = 216 = 108' 

M ^ , ,_ 4E_4_4_1 

for four elements I - ^^ — - 32+2OO ~ 232 ~ 58 ' 



PHYSICAL INTEODUCnON. 27 

i.e.9 we have almost doubled the strength of the current by doubling the 
number of elements, and almost quadrupled it by quadrupling the number. 
On the other hand, let us assume that, under the same conditions, the 
element is enlarged, t.e., the essential resistance is diminished. Assuming 
the same resistance as above, it will be found that in 

an element twice as larcre I = , ^^ ^ •: — =—; = ^rx-, » 

o«iu»ib« ^W + w; 4+200 204 

so that the strength of the current has been scarcely affected. 

This will occur at once, however, if the essential resistance is greats 
the extra-essential resistance small, as in the galvano-caustic battery. 
Assuming now that W = 200, w = S, it follows that 

for one element I = ^-^ = 2oFJ^ = 4 ' 

E 11 

for an element twice as large I = 



^W+to 100+8 108' 

E 11 

for an element four times as large I = ,„. — = ^7^ — rr = Po« 

iW-hu7 50H-8 60 

It is evident, then, that the intensity of the current is increased by enlarge- 
ment of the elements, but not by any increase in the number of elements. 

The simple conclusion follows for our purposes that, in the percuta- 
neous application of the current for ekctro^herapeutical objects, a greater 
intensity of the current (assuming a given electro-motor combination) can 
be obtained by an increase in the number of elements and not by an enlargement 
of the individual elements. 

6. The conception of the density of the current is of special importance 
with regard to a comprehension of the effects of the current and its proper 
practical application. 

The experience of physiologists teaches that an appreciable stimulat- 
ing effect upon the peripheral and central nervous system only ocoots 
when the current employed has a certain " density.'* It is at least proba- 
ble that a similar condition obtains also for the therapeutic effects of the 
current, that at least a considerable portion of them are alone produced 
when the diseased part is brought under the influence of a current of 
certain density. 

By the term density of the current we understand the relation of the 
strength of the current to the transverse section of the conductor through 
which it passes. This relation may be understood most readily, as I 
believe, if you consider the matter figuratively, and suppose the electrical 
current to be composed of a large number of parallel threads. 

The greater the number of threads composing a cun*ent, the greater 
is the strength of the current ; the greater the number of threads which 
are compressed into a unit of the transverse section, the greater is the 
density of the current If you imagine a current, for example, of one 
thousand threads carried through a metallic conductor, 1 sq. ctm., in 
transverse section, and then through one which has an area of 2 sq. ctm^ 



28 SLEOTBO^raBBAPEirnos. 

the thonBand threads in the second case will be dispersed over twioe a* 
great an area and the current will possess but half the density, while it 
will have the same strength in both esses. The adjacent Fig. 9. may 
serve as an illustration. The current is similar to a girl's looee hair, 
which may be gathered into a thin coil without changing the number ot 
the hairs. 

It seems that appreciable physiological and therapeutical effects do 
not begin until the number of threads of current, 
passing through the transverse section of the HTiim al 
tissues, exceeds a certain limit It is therefore impor- 
tant to obtain a clear idea of these relations and tc 
render evident those measures by which it is possible 
to bring any part ot the body desired under the influ- 
ence of a current of a certain density. 

For this purpose you must, above all, form an idea 
of what occurs with the current and its threads, when 
we introduce them into the body in the ordiuary man- 
ner, i.e., from two points on the surface of the body, 
by means of electrodes which are applied to those 
parts. A number of threads of current corresponding 
to its strength here enters the body, and is dispersed 
in all directions according to Ohm's laws. All the 
threads of the current enter through the surface of 
the electrodes, and are then spread over the much 
larger area of the body or parts of the body. The 
a _6ch uio P"®"**^* density, therefore, must always be present in 
Sni3r"rfu«m™?!u *^^ immediate vicinity of the electrodes, and, if these 
Mmcth nnii»iniii( t^ ^rs of cqual sizs, the density of the current vrill be 
^i"!*!:?',?. ™^"' '" equal at both electrodes {vide Fig. 10) ; if the elec- 
ti«if ths trodes are of different sizes, the greatest density will 
T>t<riD* be found at the smaller one, because the same number 
of threads of the current are here compressed into a 
smaller space (vide Fig. 11). 

In the interior of the body the greatest intensity of the current will be 
found in the strnight line connecting the electrodes (because this presents 
the least resistanrel, the largest number of threjids of the current will here 
be accumulated and, therefort*, the relatively greatest density of the cur- 
rent will also be found in thM situation. But this cannot be very Inrge, 
since, on account of the ^«^t area of the body and the approximately 
equal conductivity of its parte, the density must diminish markedly very 
close to the electrodes. However, in especially favorable si tn. if ions -tor 
example, in transverse conduction through the head with toleiahlv Inrge 
electrodes, or in transverse conduction through nn osti-eiuity — a quite 
oonsiderable density of the ci>/Fant may be secured, even in the depths of 



FHTSIOAL UTTRODnonOIT, 29 

Aooording to the relative position of the electrodeH, the zone 
of relatiTely greateet density of the oarrent between the electrodes will 



YBTj somewhat in shape ; in transverse pass^e of the current through 
the body or individual parts this zone will have the shape of a bellied 
cylinder, extending from one electrode to the other, as in Fig. 12 ; if, 
on the other hand, the electrodes are placed near one another upon the 
mrfsce of the body, it will assume the shape of a section of a sphere or 



Hm et ttio iltBiltjr of On CBrrnt^ In IW tnnir 
itlon of ttie doudty of tb 



bod*' Tbfl Ineffective thnAda of canvnt ■!« dotted. The ftpproxloulfl 
Fi o. 18 .— Hctitmiif " ■ 

(^linder, the base of which corresponds to the surfece of the body, as 
represented in Fig. 13. Those parte of the body situated outside of this 



so XLEOTBtKrHEBAFBCnOS. 

MBa, Blthoagfa they oontain a certain Dumber of threads of onmnt (•«• 
cording to Ohm's laws), nevertheleaa present such a slight denafjj of 
current that they may be left entirely out of consideration. 

This subject constitutes the quintessence of electzo-therapeutical tech- 
nique. Our object almost always is to localize the current in a certain 
density upon definite parts of the body, and this can be done only by hav- 
ing a clear idea of the facta just developed with regard to the strength and 
density of the current. Upon this depends exclusively the choice of the 
electrodes and their points of application for onr rarioua purposea. Yon 
wiU. allow me to illustrate this by a few important examples, 

If you wish, a, to localize the current with a certain intensi^ and den- 
sity upon one definite point, not for removed from the surface, two elec- 
trodes ol difibront eizes are emjdoyed, the smaller one being plaoed aa near 




as possible to the point in question, the larger one (as large as possible) 
at a considerable distance ; the end desired will be attained so much moie 
certainly the greater the difference in the size of the electrodes. {If one 
is very small, the requisite intensity of the current must be secured by an 
increase in the number of elementa, as the smaller surface of the electrode 
causes a considerably greater resistance.) This is the method employed 
daily in the electrical examination of individual nerves and branches of 
nerves, in local stimulation of these porta or of the motor muscular points 
for therapeutical purposes, etc. 

If you wish, 6, to localize the current upon larger parts near the surface 
you should choose two moderately large electrodes of equal size and appl,i 
them in quite close proximity upon the pnrt of the body in question, so 
that the latter falls within the spherical segment of relatively greatest den- 
si^, as shown sohematioBlly in Fig. 13. This method should be adopted, 



PHTSIOAL INTEODOCnOK. 81 

tot axucapLd, if jroa desire to eleotrize energetloally the deltoid or bicepe^ 
the glutteuB or vastus iQlentus or att enlai^ed joints eta 

If you intend, c, to localize the current in parte Bituat«d deeply, the 
electrodes ahould be as large aa possible and be placed upon the part in 
uuestion at the greatest possible distauce from one another. The closer 
the electrodes are to one another the greater will be the difference be- 
tveen the length of those threads of current which pass superficially aod 
those which pass deeply from one electrode to the other, and the greater 
the number which will remain near the surface. If the eleotrodea are 
widely separated this diffbrenoe will become less, and comparatively more 
threads of ouirent will pass into the deeper parte, as is shown in Fig. 14. 
Tim method is e^ieoially employed in the treatment of the spinal cord, 
which is relatively far removed from the sur- 
face ; the rule here la " large electrodes, widely 
separated." 

Or two electrodes of equal size are employed 
and applied in such a manner that the part in 
queetion is aituated, as br as possible, in the 
straight line connecting them. This method is 
especially adapted for treatmeot of deep-seated 
diseases of the brain (as is shown clearly in the 
adjoining figure), but may also be employed to 
infiuenoe droumscribed spots of disease in the 
qunal cord, for the treatment of morbid pro- i^l^u^*!! 
oesses situated deep in the viscera, etc. }^ 

These three methods of appHoation will auf- hi^^thll^'o?raJreni'' *"'' '*' 
fioe under all circumBtances. 

It is worthy of notice that these conditions of dispersion of electrical 
currents in the human body hold good chiefly, as it seems, for the galvanic 
current, at least so far as the action upon deeper parts is concerned. As 
Uelmholtz has shown, the faradic current appears to act somewhat differ- 
ently in this teepoct, and does not enter deeply with the same rajudity and 
readiness as the galvanic current. This will explain various electro- thera- 
peutical experiences, such as the foci that deeply situated nerves and mus- 
cles are much more readily stimulated by the galvanic than by the faradic 
current, that the latter does not produce the expected efiect upon the 
spinal cord and brain, the viscera, etc. This is of practical importance. 

I will finally refer briefly to two physical effects of the current, which 
are, perhaps, of no slight significance in electro-therapeutics. 

The first ia the electrolytic action of electrical currents. You are ac- 
quainted with all the details of this action, and I need remind you merely 
that in the passage of the ourrent through certain compound conductors 
(electrolytes), these are decomposed into their component parts, the latter 
being given off at the two poles — the so-called electro-negative elements, 



32 ELEOTBO-THEBAPEUTICS. 

oxygen, iodine, chlorine, etc., and the acids, at the anode, the electro-posi- 
tive elements (hydrogen, potassium, sodium, copper, etc.), the alkalies azid 
bases, at the cathode. 

Similar phenomena also occur in animal fluids and tissues ; as Dubois- 
Beymond, Hermann, and others have shown, the electrolytic processes 
occur whenever a current passes from another conductor into an electro- 
lyte, when two electrolytes are in apposition and also in the interior of 
firm masses which are permeated by an electrolyte and through which a 
current is flowing. The animal organism, when penetrated by an elec- 
trical current, presents such a condition ; electrolytic processes will there- 
fore develop within it 

But decomposable fluids, electrolytes, are present also in the elements 
which produce galvanic currents, and these are subject to electrolysis 
during the closure of the current Ions will be separated in a gaseous or 
solid form at both metal plates, and new electrical currents thus develop 
in the chain, enfeebling the original main current This process is called 
polarization of the current This is the cause of the inconstancy of the 
ordinary simple chains, i.e., that their electro-motor force gradually dimin- 
ishes during the period of closure. You all know of the attempts which 
have been made to prevent polarization and produce so-called constant 
elements. This has been effected in the elements of Daniell, Bunsen, 
Grove, Pincus, Leclanch6 and others. These are matters of the greatest 
interest from a physical point of view and for certain technical purposes. 

For our purposes, however, really constant elements are an unnecessary 
luxury, since, on the one hand, even inconstant chains will suffice during 
the short period of the application of the current, and, on the other hand, 
even the most constant elements can never succeed in producing an ap- 
proximately constant ourreut in the human body. 

The various forms of current produce very different degrees of electro- 
lytic action ; by far the greatest is possessed by the galvanic current, 
much less by the magneto-electric induction current, and still less by the 
faradic current This is supposed to depend on the very different dura- 
tion of these currents. 

The other physical effect to which I wish to call attention is the so- 
called mechanical or cataphoric action of the electrical current It is pos- 
sibly of great importance in therapeutics and depends upon the fact that 
during the passage of a current through an electrolyte contained in porous 
bodies, fluid is impelled from the anode to the cathode, te,, in the direc- 
tion of the positive current. The amount of fluid moved in the porous 
body in a unit of time is so much larger the stronger the current and the 
poorer the conducting power of the fluid. Firm particles, suspended in 
the fluid, are said to move in the opposite direction to the fluid itself. It 
is evident that the animal tissues are constructed in such a manner as to 
allow the production of these cataphoric effects. 



PART n. 



PHYSIOLOGICAL INTRODUCTION. 



LECTUEE IV. 

Sffeote of Bleotrioal OnrreBtB on the Healthy, Living Body— Eleotro-Flijsiologjr of Ik* 
Motor Nervea and the Muscles — Stimulant Action — Pliueger's Law of Contractioii 
— Action of the Poles — Law of Contraction of the Motor Nerves in the Living 
Body — Polar Method of Examination — Law of Polar Contraction and its Different 
Grades — Faradic and Galvanic Reaction of the Muscles — Eleotrotonio Phenomena 
— Electrotonus in the Living Body —Modifying and Exhilarating Effects. 

I NOW pasa to the discussion of the physiological effects of electricity 
upon the living body. We will first investigate in what manner the elec- 
trical current influences the individual organs of the human body under 
physiological conditions, and what consequences follow its application to 
these parts. Important deductions may thence be drawn, both with re- 
gard to diagnosis as well as treatment of morbid conditions. The eleo- 
tro-physiology of the nervous system and of the muscles teaches us a largv 
number of most important and interesting facts, and has led, in many re- 
spects, to a depth and exactness of knowledge, such as are scarcely ex- 
celled in any other branch of physiology. 

The action of electrical currents upon ttie motor nerves and muscles 
is best known and has been most thoroughly studied. 

I turn first to the motor nerves, paying special attention to the stimu- 
lating effects of electrical currents upon them. 

It is a fact which can be demonstrated at any moment that the motor 
nerves of man or the vertebrates, either laid bare or in situ, can be irri- 
tated by the application of electrical currents (faradic or galvanic), and 
that this irritation makes itself apparent by a muscular contraction (in the 
muscle supplied by the irritated nerve). 

This irritation is determined by the law formulated by Bubois-Iley- 

mond : *' The absolute amount of the density of the current at any certain 

moment does not act as a stimulant to the motor nerves, but merely the 

change in its amount from one moment to another, i,e., only the variations 
3 



34 ELECTRO-THERAPEUTICS. 

in the density ; these act so much more powerfully the greater they are 
in a unit of time, or, their amount being equal, the more rapidly they 
occur ; most powerfully, therefore, upon sudden closure and opening of 
the current.'* It therefore follows that, as a rule, a constantly flowing gal- 
Tanic current does not produce any stimulation during its duration ; fur- 
thermore, that very gradual diminution or increase of the current remains 
without any visible, stimulant efifect, even for a great strength of the cur- 
rent ; and finally, that simple variations of density, the current remaining 
closed, may act as a stimulant, provided that such variations occur in 
sufficient amount and with a certain rapidity. 

Hence follows, also, the vigorous irritative efifect of faradic currents 
upon the motor nerves, because they are composed of currents of very 
brief duration and thus produce very considerable and very sudden varia- 
tions of density. If induction currents are allowed to act upon the motor 
nerves, each one wiU be followed by a short muscular contraction, corre- 
sponding to the strength of the induction current ; the contractions, 
therefore, are more vigorous during the opening than during the closing 
current of the secondary spiral. If a series of such currents act upon the 
nerves, an identical series of muscular contractions will follow ; if the suc- 
cession of these irritants attains a certain rapidity, the individual contrac- 
tions will be collected into a single permanent, so-called tetanic contrac- 
tion. It is unnecessary to enter into the details of the irritant efifect of 
faradic currents ; it will suffice to mention that usually the individual in- 
duction currents act merely like closure of the current, the opening pro- 
ducing a scarcely noticeable contraction. 

Every sufficiently large variation in the density of a galvanic current^ 
if conveyed to a nerve, produces an irritation of the nerve and at the same 
time a muscular contraction ; this occurs most certainly during the varia- 
tions of density connected with making and breaking the current It was 
early recognized that the stimulant efifects upon opening and closing cur- 
rents of various strengths, and also on changing the direction of the current 
in the nerve, are very different, and much labor has been devoted to dis- 
covering the relations of these dififerences. These have been formulated by 
Pflueger in his law of contraction. This law — which holds good only when 
the nerve is laid bare and well isolated — is as follows : 

With tueak cturents, in both directions, contraction occurs on closure 
alone, but none is produced on opening ; the contraction on closure of the 
ascending current is somewhat stronger than that of the descending ; 

With moderaie currents, contractions occur on opening and closing in 
both directions ; but the former are always weaker than the latter ; 

With very strong currents (such as are never employed upon human 
beings), contraction occurs on opening but none on closure of the ascend- 
ing current ; and it also occurs on closure but not on opening of the de- 
scending current 



PHYSIOLOGICAL INTRODUCTION. 35 

All these phenomena and phases of the law of contraction are based 
upon well-founded facts. The most important of these is that the irrita- 
tiye effect of the galvanic current occurs only at the poles and starts from 
them ; the irritation on closure occurs at the cathode alone, on opening at 
the anode alone. Pflueger also found that the irritant action of the cath* 
ode is greater than that of the anode, and thus the irritation at the closuro 
of a certain current is greater than at the opening. It was further found 
that the more central portion of a motor nerve is more irritable than the 
peripheral portion and, finally, that with very strong currents considerable 
resistance to the propagation of the irritation occurs at both poles, and in- 
creases with the strength and the period of closure of the current. Pflue- 
ger's law is thus explained in the simplest manner : with tveak currents, 
contraction occurs only on closure in both directions of the current, be- 
cause contraction on closure is the stronger and appears first ; contraction 
on closure of the ascending current appears somewhat earlier because the 
central part of the nerve on which the cathode is placed is somewhat 
more irritable. When the current is moderate!)/ strong, the closure con- 
traction in both directions of the current is stronger than the opening 
contraction on accoimt of the predominant irritative effect of the cathode. 
When the currents are very strong, the resistance to conduction, which 
develops at the poles and disappears but slowly, inhibits the propagation 
of the closure irritation when the current is ascending, and the propaga- 
tion of the opening irritation to the muscle when the current is descend- 
ing, and thus produces the peculiar third stage of the law of contraction. 

It follows from the previous remarks that the phenomena of the law of 
contraction depend alone upon the different effects of the two poles, and 
tiiat the irritation on closure (Ca action) is considerably greater than that 
on opening (An action). 

When the current is strong, its closure is not followed by a simple short 
contraction, but often by a long-drawn tonic or tetanic contraction which 
gradually subsides (closure tonus or closure tetanus, C Te). An entirely 
satisfactory explanation of this phenomenon has not been offered, and I 
have referred to it because it is readily produced in the human subject. 
Opening tetanus, %,e,, a vigorous opening contraction of a tonic, protracted 
character occurs only in such nerves whose irritability has been very much 
increased ; it is readily explained by Pflueger*s law of electrotonus. In 
the human subject it occurs with extreme rarity and, as it seems, in patho- 
logical cases alone. 

Pflueger*slaws also explain another phenomenon which was first known 
as Yolta's alternatives ; if the current has been closed for some time in one 
direction, the irritability of the nerve is increased to opening in the same 
direction or closure in the opposite ; repeated changes in the direction of 
the current therefore produce a considerable increase in the amount of 
contraction. This cannot be entirely explained by the diminution in the 



36 



ELEOTBO-THEBAPKUTIOS. 



lemfltoDoe to conduction, but rather by the samiuKtion o( the imtBting 
effect o{ the anode (disappearanoe of anelectrotonus) and of the cathode 
(deTelopment of catolectrotonus) at one part of the nerre (alternating at 
each change of polarity). 

Bompf has recently shown, by a seriee of physiolc^cal experiments, 
that, in a motor nerve which ia still connected with the central organ, the 
opening contraction of the aacending current occurs oonsidersbly later 
than in one which ie separated from the central organ. This is obaerred 
occasionally under pathological conditions. 

I will add further that motor nerves are entirely non-irritable to the 
strictly transrerse passage of the current (faradic or galvanic), and also to 
very short (under 0.0015 second) galvanic cnrrenta, a characteristic^ how- 
ever, which is much more marked in muscles. 




For the practical physician, however, the question arises whether the law 
of contraction can be demonstrated upon the motor nerves of the hving and 
healthy human being. Experience teaches that this is possible, despite 
the great obstacles presented. But our experiments on this subject can- 
not compare in exactness with those of the physiologist. We have to deal 
with nerves which are surrounded by more or leas thick layeraof good con- 
ducting tissues and which are followed by a largo number of the threads 
of current ; we cannot therefore maintain uniform density of the current in 
the nerve. The greatest density of the current will be found immediately 
beneath the electrodes ; even in the intrapohu- portions of the nerves, the 
density will soon become so slight, if the electrodes are not closely ap- 
proximated, that a part of the nerve may be regarded as not traversed by 
the current. And it will be impossible to maintain a definite, single di^ 



PHYSIOLOGICAL INTRODUOTIOir. 87 

• 

reetion of the current in the liying nerve, Borrounded as it is by soft parts. 
A glance at the adjoining plate (Fig. 16), wiU show that in ordinary per- 
cutaneous application, not less than three, perhaps even four efScient 
directions of the current must be present in such a nerve. 

The direction of the current must therefore be left out of considera> 
tion ; we must endeavor to find a law of contraction of the living motor 
nerves in the healthy body, without any reference to the direction of the 
current. 

In fact, there is no doubt that the problem may be simplified by 
merely testing the action of the poles in the living human being. This 
problem is solved without much difficulty. If but one pole is brought 
into the immediate vicinity of the nerve to be tested, and the other re- 
moved as far as possible, the density of the current tmder the first pole 
ivffl be to great that its action will be brought into play almost ezdu- 




VMb IT.— SdmiBllo mw emi U tton of the primary and moimdtarj (Ttrtiial) polar aofelOB upon ontpolar 

appUoation of the electrode over a nerre-traiik. 

sivefy, this may then be examined separately on closure and opening, and 
with an increasing strength of current. This is the so-called polar method 
of examination from which Brenner developed also a polar method of 
therapeutics. 

But this method also presents difficulties and peculiarities. We can 
by no means produce an entirely isolated action of the poles in any nerve ; 
if the current enters a nerve at any point (that is, if there is an anode 
at any part of the nerve) it must make its exit at some other, perhaps at 
various places (i.e., it must have a cathode somewhere). It will depend 
solely upon the density of the current of exit in how far this second, 
virtual, pole comes into play. In fact, a glance at Fig. 17, will show that 
an isolated pole placed upon a nerve must have not alone one, but even 
two opposite poles in its immediate neighborhood. If the current enters 



38 ELEOTRO-THEBAPEUnCS. 

through the anode in a certain density the threads of current will flow 
along both directions of the nerve with diminishing density ; the cathode 
may be regarded as present at the point at which the density has become 
so slight that the current is ineffectiye. Every anode is therefore sur- 
rounded by two cathodes of much less density, and the reverse occurs 
when the isolated cathode is applied to the nerve. Under all circum- 
stances, in this method of application, in addition to the action of the 
pole applied directly, we must therefore expect to find the action of the 
opposite pole, though very much enfeebled. 

In the polar method of examination one electrode, termed the " active " 
one, is brought in as close approximation as possible to the nerve to be 
examined, and then connected, as desired, vrith the An or Ca of the bat- 
tery. The other or " indifferent ** electrode is placed on some remote 
part of the body (stemuin, i^ine, epigastrium, popliteal space) ; I always 
employ the sternum, to which the electrode can readily be applied by the 
person examined. 

The requisite making and breaking of the circuit are best done by 
means of the metallic polarity changer ; if the Ca is on the nerve and the 
circuit is closed this is called '' making a cathodal closure," Ca CI ; if the - 
circuit is opened, *' cathodal opening," Ca O ; and similarly vnth the anode. 

It is best to begin (virith a definite slight strength of current) by ex- 
amining Ca C in about three closures, and at the same time observing Ca 
O ; An C and An O are then examined in the same manner ; to secure the 
opening contraction it is advisable to keep the current closed for a little 
while, as this increases the irritability on opening the circuit. With an 
increasing strength of current we then examine at what intensity the vari- 
ous forms of contraction are produced, and can then arrange them in a 
formula, in which the various degrees of contraction are represented as C, 
C, C", or C, CC, CCC, etc, according to the strength of the contraction. 
In making these examinations you should employ the greatest similarity 
and regularity of method, because in this way alone can you arrive at re- 
sults which may be compared vrith one another and can avoid, to a certain 
extent, the numerous sources of error of such investigations in the human 
subject 

By this method you may readily demonstrate, in the majority of the 
motor nerves, that the cathode chiefly produces stimulation on closure, the 
anode chiefly on opening ; you vriU also find that the stimulant action of 
the cathode is much greater than that of the anode. 

From these statements it is evident that the first contraction which oc- 
curs upon stimulation of a motor nerve is Ca CI C. As an illustration let 
us take the ulnar nerve. You will find that, perhaps with eight elements, 
Ca CI C first develops, but no contraction occurs at Ca O, An CI, and 
An O ; with ten elements, Ca CI C becomes stronger, and a feeble An 
CI C occurs ; perhaps also a feeble An O C. With twelve elements, Ca 



PHYSIOLOGICAL INTRODUCTIOir. 89 

01 C becomes yery aotiye, perhaps assumes a slight tonic character (weak 
Ca CI Te), An CI C and An O C become stronger, especially the latter ; 
Ca O is still inefficient Finally, with fourteen, sixteen, or eighteen ele- 
ments, you will observe Ca CI Te', An CI C, An O C, and finally distinct 
Ca O C, though this always possesses little strength. 

We may therefore distinguish three stages of the law of contraction. 

First stage (feeble current) : Ca CI C. 

Second stage (moderate current) : Ca CI C stronger. An CI C and 
An O C also occur, both of approximately equal strength, though some- 
times one, sometimes the other develops a little earlier in diiSerent nerves. 
The latter differences are undoubtedly due to the anatomical position of 
the nerves and to the density of the threads of currents producing the 
secondary polar action which is dependent thereon. 

Third stage (strong current) : Ca CI C becomes tonic and = Ca CI 
Te ; An CI C and especially An O C become more powerful, and at the 
same time weak Ca O C occurs. 

Further stages do not occur in the living, healthy individual ; a still 
higher stage would be the occurrence of anodal opening tetanus, but this 
has not been observed to my knowledge in the healthy motor nerves of 
man. With very high strengths of current, it is easier to produce a slight 
prolongation and tonic character of An CI C. 

In formulating the law of contraction, Brenner has introduced a very 
simple and practical formula, which contains the six possible stimulant fac- 
tors (Ca CI, Ca D = cathodal duration, i,e., the period of closure of the 
circuit ; what is termed closure tetanus is a Ca D reaction, and Ca O, An 
CI, An D = anodal duration. An O), next to which the strength and dura- 
tion of the contractions may be appended in a manner readily understood. 
The following is the formula for the three stages of the law of motor oon-* 
traction: 



Fintstiigti 


Seoond aUge; 


Third stage. 


Caao 


Cacac 


Ca ca C" 


CaD- 


GaD 


CaDO 


CaO- 


CaO- 


CaOC 


AnCl- 


AnClC 


An ca C 


AnD- 


AnD— 


AnD- 


AnO- 


AnOC 


An O C 



The above mentioned facts vrill be made clearer, perhaps, by the sche- 
matic representation of the different strengths of the contractions in the 
individual factors of irritation. The strength of the individual contrac- 
tions in any nerve is, cceteris paribus, the product of the amount of irrita- 
tion of the acting pole (I) and the density of the current at the point of 
irritation (D), i.e., C = I D. We will assume that the amount of irritation 
of the Ca = 1, of the An = i. We will also assume the density of the 
current at the active electrode (in the most shaded part of Fig. 18) = 1, 



40 XLSCTRO-THnAFBUTICS. 

and* <m the other hand = ^ at the point of aeoondarj pdar aottcm (ift tte 
lightly shaded parts above the electrode). 

If the Oa is the active electrode, it acts npon closure of the current 
with an amount of irritation 1 and density 1 ; Ca CI C is therefore 1x1, 
and has the strength 1. Upon opening the current, the irritant actioii 
occurs at the virtual An with an amount of irritation of the An = ^ and a 
density ^. Ca O C accordingly is ^ x ^, and has a strength ^. 

If tlie An is the active electrode the stimulation upon dosnre ol the 




Denrilif si 



no. IB^— B o hmi m f i fi t i pw i nf tlo ii of tb« rmryiag deiuttjat the Mthr* (— ) nd tlWTlctad (•f)pete 

npoa unipolar appliotttioii of the Ca to the nenre. 

oonnent occurs at the virtual cathode, with an amount of irritatkm of the 
Ca = 1 and density ^ ; An CI C accordingly is 1 x i, and has a strength 4. 

Upon opening the current the irritation occurs at the An itself, witn 
an amount of irritation i and density 1 ; An O C accordingly is ^ x 1 and 
has a strength i. 

For a definite strength of current, tl^e amount of contraction vrith the 
various forms of stimulation may be accordingly formulated as foUows : 

Ca CI C = 4 
AnaC= 2 
AnO C = 2 
Ca O C = 1 

The electrical irritability of the voluntary muscles has long been a sub- 
ject of dispute and never-ending labor to the physiologist. The much-dis- 
puted question whether the muscles possess irritability independent of 
the motor nerves (or more properly stated, whether the undoubted irrita- 
bility of the muscles can be brought into action by other means f^^^ 
through the motor nerves) appears to be settled finally, and the occurrence 
of muscular irritabiHty to be established beyond a doubt This question, 
of purely theoretical interest to the physiologist, has a not inconsiderable 
significance to the pathologist, since, apart from pathological irritative pro- 
cesses in the muscular tissue itself, we meet not infrequently with morbid 



PHTSIOLOOIOAL INTBODUOTION. 41 

in which Wuscular irritability is demonstrable apart from all 
aetton on the part of the motor nerves, and oan be emplc^ed by ns for 
imfMxrtant diagnostic and prognostic purposes. 

It has been found by physiologists that Dubois-Beymond's law of 
stimulation also holds good for the musdes. 

The muscular tissue reacts much less than do tiie nerves to currents of 
▼ery short duration ; its irritation by faradic currents is therefore some- 
wbat more difficult than by galvanic. 

But the faradic current acts upon the muscle, as upon the nerve, vrith 
a «oatractaoQ at each single induction stroke of a certain strength, and 
with a tetanic contraction upon a rapid succession. 

The law of galvanic contraction of the muscles appears to be entirely 
analogous to that of the motor nerves, and to depend upon the fact that 
the closure stimulation occurs alone at the Ca, the opening irritation alone 
at the An. With a moderate strength of current closure and opening con- 
tractions occur at both poles, but the latter are much weaker and often 
entirely absrait ; an opening contraction only occurs regularly with greater 
strength of current and very prolonged duration of closure. With strong 
currents a certain degree of shortening of tiie muscles remains after the 
doBure as well as the opening contraction (closure and opening duration 
eontraotion). 

The examination of direct muscular irritability in the human subject, 
meets vnth special difficulties, and we possess very little definite knowledge 
OB this subject. 

The living musdes react with more or less vigorous tetanic contrac- 
tion (according to the strength of the current) to faradism, and with single 
contractions to individual induction currents. This occurs so much more 
readily the closer the electrodes are approximated to the points of en- 
trance of the motor nerve-branches into the musde, or touch these direct- 
ly (motor points). Upon this depends the method of local faradization of 
the muscles. 

The galvanic reaction of the musdes occurs in such a manner that 
they respond to stimulation with both poles by a dosure contraction alone, 
the opening contraction being absent or obtained only exceptionally. The 
latter fact is perhaps explained by the slight irritability of the musdes to 
the short opening irritation. The closure contractions are short and vig- 
orous, but frequently they do not seem to me to be as prompt as after 
irritation of the nerves ; they often show a slight tendency to tonic con- 
traction, but are never markedly slow. 

But Ca CI C is not much greater than An CI C, and this is a distinct 
difference from the normal condition of the nervea 

To a certain extent, an isolated irritation of the muscles of the body 
by the galvanic current, a local galvanization, may be effected, and is 
baaed upon the same prindples and methods as local faradization. 



42 ELECTR0-THEBAPEUTIC8. 

A second, yery important group of effects of the electrical current upon 
ihe motor nerves are the so-called modifying, irritability changing, electio> 
tonic effects. We mean those effects of electrical, especially galvanic, 
currents which are expressed by a change in the electrical, thermal, or 
mechanical irritability of the motor nerves (and muscles) during the 
passage and after the cessation of the current ; these are included und^ 
the term electrotonic phenomena. 

The following are the essential features of the doctrine of eleotn>- 
tonus: 

A galvanic current passing longitudinally along a motor nerve (polar- 
izing current) changes its irritability along the entire length most markedly 
in the vicinity of both poles. At the cathode and its vicinity the elec- 
trical, mechanical, and thermal irritability is increased (catelectrotonus) ; 
at the anode and its vicinity it is diminished (anelectrotonus). "Boih in- 
crease with the duration and intensity of the polarizing current and 
touch one another in an indifferent point of the intrapolar region. The 
change of irritability is greatest at the electrodes and diminishes in a 
curve on each side ; within the intrapolar region this curve cuts the line 
of co-ordinates at the indifferent point 

Upon breaking the polarizing current the negative modification of the 
irritability of the anode (anelectrotonus) is changed at once to a very 
marked positive modification, which requires some time for its disappear- 
ance ; at the Ca, on the other hand, a brief negative modification of 
irritability first occurs, but very rapidly passes into a vigorous positive 
modification with increase of the irritability, and then gradually returns to 
the normal condition. After breaking the polarizing current, therefore, a 
more or less prolonged increase of irritability persists at both polea 

Many attempts have been made to demonstrate the electrotonic phe- 
nomena in the living human subject, and these attempts may, in the main, 
be regarded as successful 

However, the first attempts made by Eulenberg and by myself fur- 
nished diametrically opposite result& Eulenberg*s result coincided en- 
tirely with those obtained by physiologists ; mine showed diminution of 
irritability near the Ca, increase of irritability near the An. But I am per- 
fectly satisfied with regard to the correctness of my results. They are ex- 
plained by the dispersion of the current and the rapidly diminishing 
density in the vicinity of the polarizing electrodes, i.e., by the two virtual 
electrodes of an opposite sign which are present in the neighborhood of 
each electrode {mde Fig. 17). If, in view of these considerations, I placed 
the irritating electrode immediately at or vrithin the polarizing electrode, 
regular catelectrotonus and anelectrotonus was presented, as in physiologi- 
cal experiments. These phenomena have also been studied by others, 
though imsatisfactorily, and a review of the entire question is desirable. 
For the present we may remain satisfied with the result that it is possible 



PHTSIOLOaiOAL INTRODUCTION. 4& 

to demonsiarate the electrotonio phenomena npon the motor nerves of the 
living human subject But we recognize the fact that the conditions are 
much more complicated than in the isolated nerve-musde preparation, and 
that we are unable to polarize longer stretches of the nerve in a uniform 
manner. Indeed, as shown in the adjoining figure (Fig. 19), we always 
obtain a series of not less than six — or in unipolar stimiQation, at least 
three — anelectrotonio and caklectrotonic portions of the nerve. 





Fto^ 10. — Scbematlo rsprMenUtkm of TaiyiiiR polarization of the nerre in bipolar percntaneooa applloa- 
tlan of tha daotrodaa. Tha anelec tr otonio parta are ihoded transvcraeiy, the cataloctrotonic parta vcrtloally. 

Of more importance to the therapeutist are ike more or less persistent 
effects which remain after opening the circuit, i.e,, the — ^perhaps perma- 
nent — modification after opening the polarizing current Physiology 
teaches that, under these circumstances, an increase of irritability remains 
at both poles ; but the rapid return to the normal condition is by no 
means very promising vnth regard to permanent changes imder patho- 
logical conditions. 

The attempt has been made to demonstrate this positive modification 
upon the intact nerves of the human subject. Bemak, in his experi- 
ments, came to the conclusion that cathodal duration produces a positive 
modification of Ca CI C, but this occurs after anodal duration to a slighter 
degree, and only when the experiment is modified. These results need 
verification ; their real utiUty in therapeutics is very problematical 



LECTURE V. 

Beotro-phjBlology ot the Swaaorj Kenres and Kerres of 8peeUl S en ao Ekmwwy 
Kenres of the Skha and their Law of Oontraotion-^Benaoij Nenres of the Moaolea 
— Optio Ner?e and Betina^Aooostio Nerro and the Kenroua AndltoQr Appazatea 
— ^Nerres ox Taste — Nerves of SmelL 



With regard to the sensory nerves of the ddn the question 
whether the galvanic current stimulates them bj its continuous passage 
^ by variations of density alone. At all events, the application of a suffi- 
cient strength of current to the skin causes a conlinuous sensation, a pecu- 
liar pricking, and this soon passes into a uniform burning which may in- 
cMise to the most severe pain. A large share of this sensation, especially 
tiie uniform burning, may be due to the irritating effect of the chemical 
substances which are set free at the surface of the body by electrolysis r 
another part is probably due to the direct action of the current upon 
the sensory apparatus in the skin. Many physiologists lean toward the 
view that the sensory terminal organs react differently to the current than 
do the conducting paths, that they are not alone stimulated by variations 
of density, but also by the constant passage of the current This is, to a 
certain extent, negatived by the fact that continuous irritation of a nerve 
trunk causes a continuous eccentric sensation in its region of distribution. 

It is well known that experiments on animals throw a very imperfect 
light upon the phenomena observed in the sensory nerves. A so-called 
law of contraction of these nerves has only been obtained in a roimd- 
about way, inasmuch as the reflexes occurring upon irritation of them 
(in slightly strychninized animals) were employed as indications of the 
sensory irritation. By means of this method Pflueger found the law of 
contraction of sensory nerves to be in complete harmony with that of 
the motor nerves, mutatis mutandis, i.e., with the differences necessarily 
produced by the direction of the conduction in sensory nerves (for the 
third stage). 

In the sensory nerves of the human subject, however, it is evident 
that the polar method of examination is the only one which can be em- 
ployed, and that the problem consists in determining the reaction of these 
nerves at both poles on making and breaking the current, and with dif- 
ferent strengths of current. I have recently shown that there is a striking 
similarity in these respects to the law of polar motor contraction. 



PHT8IOLOOI0AL INTBODUCnON. 45 

The sensory irritations produced by the galvanic current appear not 
alone in that part of the skin covered by the active electrode, but also in 
the region of distribution of those sensory nerves of the skin whose trunk 
lies within the boundary of this electrode. With a gradually increasing 
strength of current, a brief Ca CI sensation first develops, which, with a 
stronger current, passes into a permanent pricking, eccentric, and local 
sensation, whose intensity gradually diminishes during Ca D ; then fol- 
lows a similar feebler, short An O sensation ; somewhat later a feeble An 
d sensation, which only passes into an An D sensation with still stnmger 
ourrents ; finally, with a relatively great strength of current, if the Ca I> 
sensation has been allowed gradually to subside, a feeble, but distinct, 
Ca O sensation develops (during the entire experiment a lively burning 
sensation is felt in addition to the pricking one, and is confined exacts 
to the surface of contact of the electrode). Here also it is evident thai 
the Ca chiefly produces closure reaction, the An opening reaction, and 
that the stimulant e£Eect of the Ca predominates markedly. 

The sensation produced by the action of the faradic current upon the 
nerves of the skin is a peculiar one ; every induction stroke causes a 
shorty sticking sensation, which increases, if the armature vibrates freely,. 
to a continuous pricking, and (especially under the use of dry metal elec- 
trodes, or the metallic brush) to a burning and very painful sensation. If 
a sensory nerve trunk is directly irritated, a peculiar eccentric pricking 
sensation is felt in the entire region of distribution ; this is much stronger 
on irritation with the Ca of the openinr^ current than with tiie An. 
Individual <itrokes of the current are not so painful as rapidly repeated 
ones, and the intensity of the faradic sensation or the pain increases with 
the rapidity of the intcrruptiona 

The sensory nerves of the muscles cannot be readily examined when 
isolated, except in muscles which have been laid bare by wounds, etc., or 
in complete ansBsthesia of the skin, and under these circumstances a 
sensory impression has never been observed in the muscles without a 
simultaneous contraction. Every vigorous muscular contraction is ac- 
companied by a distinct sensation, which has nothing in common with 
tegumentary sensations and may increase to actual pain during tetanic 
contraction ; this constitutes the electro-muscular sensibility. It is a pecu- 
liar, dull, tensile sensation, which is directly proportionate to the muscu 
lar contraction. This sensation also becomes distinct with strong galvanic 
currents, as soon as they produce a tetanic contraction of the muscles. 

Much more interesting results are furnished by electrical examination 
of the nerves of special sense, or rather the organs of special sense (we 
have to deal chiefly with the stimulation of terminal apparatus, retina» 
concha, semicircular canals, etc.). As a matter of course such experi- 
ments can be made upon the himian subject alone. 

\^th regard to electrical irritation of the organs of special sense, it 



46 ELECTBO-THEBAPEUnOS. 

may be premised that they react very slightly or not at all to the fturmdic 
<nirrent 

On the other hand, these organs react to the galvanic current with 
comparative, in part with extreme readiness, and they do this by their 
specific sensations ; it can be easily shown that these sensations are de- 
pendent on the influence of the two polea It is self-evident that we 
always have to deal with a direct galvanic irritation of the nervous appa- 
ratus of the special senses in question. 

The eye, ie., the optic nerve or retina, reacts most readily to the 
galvanic current You need simply pass a very weak current through the 
temples or cheeks, and flashes of light will appear on making or breaking 
the current, their intensity becoming greater with the increase in the 
strength of the ciirrent. The same observation may be made if somewhat 
stronger currents are applied at a distance from the eye, upon the neck or 
even the chest and back, thus showing the great sensibility of the retina to 
galvanic ciirrents. Helmholtz describes very accurately the sensations of 
light and color in his variously modified experiments, and endeavors to 
explain them upon the basis of electrotonic laws with reference to the 
direction of the current in the retina and the fibres of the optic nerve 
situated therein. 

But it is useless to attempt to explain the variations in the sensations 
of light by the difference in the direction of the current The anatomical 
arrangement of the optic nerve fibres in the retina renders such an at- 
tempt hopeless. 

Brenner has shown that the galvanic stimulation of the nervous ap- 
paratus of sight is essentially a polar action, and he has formulated the 
following law : 

At the application of each of the poles to the eye, a lightning-like 
sensation of light is felt upon making and breaking the cturent, though 
differing qualitatively (different colors) ; the sensations of light and color 
at Ca CI are qualitatively like those at An O, and those at An CI like those 
at Ca O ; for example ; 

Experiment a. Experiment Ci. 

Ca CI : reddish Ught whitish yellow. 

Ca O : bluish light , . . . .blue. 

AnCl : bluish light blue. 

An O : reddish light whitish yellow. 

With a current of moderate strength, the sensation is that of a sudden 
glow of light, Uke heat lightning, illuminating the dark field of vision 
and (sometimes with difficulty) permitting the recognition of a more or 
less distinct color ; this may be so decided that both poles may thereby 
be distinguished from one another after a little practice. 

In many individuals with good powers of observation a further differen- 



PHYSIOLOGICAL INTRODUCTION. 47 

iiation oocurs, inasmuch as a bright-colored, shining patch appears in the 
centre of the field of vision ; this is surrounded by a paler glow of light, a 
aort of drde. This is shown bj the following illustration : 

Oa CI : blue centre, yellowish green rim. 
Ca O : yellowish green centre, bright blue rim. 
An CI : yellowish green centre, bright blue rim. 
An O : blue centre, yellowish green rim. 

The colors vary greatly in different persons, but they are always alike 
in the same individual. 

The chief phenomena of the galvano-optic reaction in most individuals, 
who possess a certain gift of observation, can be obtained with readiness 
with a very slight strength of current (4-6-8 elements, the indifferent 
electrode being placed upon the neck or sternum, the active one upon the 
closed lids or the temples, in a moderately darkened room). 

It is noteworthy from a theoretical point of view that Ca CI and An O, 
and also Ca O and An CI, produce qualitatively identical sensations. The 
conclusion might be drawn that Ca at opening and An at closure have a 
definite stimulant effect different from the closure stimulation of Ca and 
opening stimulation of An ; but it is more correct to assume that the 
difference is due to a change in the locality of irritation in Ca O and An CI, 
since these must be regarded as secondary polar effects (of the virtual 
An and Ca). 

It would be interesting and important to know whether the galvanic 
visual sensation occurs from iiritation of the retina or optic nerve, or from 
irritation of the layer of nerve fibres in the retina, but this question is still 
undecided. 

I will also make brief mention of the reaction of the iris to the electri- 
cal current. Its muscular tissue reacts promptly to the feuradic current, 
and, by a suitable arrangement of the electrodes, the sphincter pupillae and 
dilator pupilke can be made to contract separately ; this can also be done 
by stimulating their nerve trunks (motor oculi communis and cervical 
sympathetio). 

The latter has not been effected hitherto in the human subject ; the 
direct stimulation, also, has been tried by very few (Duchenne), and is 
only possible in chloroform narcosis or amesthesia of the cornea. Two 
fine wire electrodes (best armed with the same pole, the other being placed 
upon the trunk) are applied 2-3 mm. from the edge of the cornea ; with a 
sufficient strength of current, marked contraction of the pupil will occur. 



Attention has long been paid to the galvanic stimulation of the audi- 
tory apparatus, but it was reserved for Brenner to demonstrate its law of 
contraction. 



48 BLBOTBCKTHEBAPKUnOS. 

Stimulation of the aooustic nenre in healthy persons is not eaqr ; tibe 
nenre is situated so deep that quite strong currents are necessary ta pio> 
duce irritation, and these give rise to such disagreeable aiixiliaiy phenom- 
ena (from irritation of the eye, sensory nerves, nerves of taste and saliva- 
tion, facial nerve, and especially the brain) that many healthy individuals 
only accustom themselves gradually to observe the auditory sensationa 
Were it not for the fact that so many patients suffering from ear diseases 
present a very marked increase of galvanic irritability, we would, per- 
haps, still be searching for the law of stimulation of the normal auditory 
apparatus. With perseverance, however, this can also be determined in 
the majority of healthy individuals. 

This is done at present by the so-called external method; a large 
moist sponge electrode (" medium size ") is placed immediately in frcHit 
of the auditory canal, pressing slightly upon the tragus, but without oc- 
cluding the canal or filling it with water. The indifferent electrode is 
placed on the back of the neck. The strength of the current being in- 
creased, repeated cathodal closures, at times An CI are made, or, if the 
irritability is very slight, repeated changes of polarity ; the person ex- 
perimented upon is directed to pay close attention to his auditory sen- 
sations.* 

An extremely simple formula vnll thus be elicited ; the normal auditoiy 
apparatus only gives a sensation at closure upon irritation vrith the Ca, 
and only at opening upon irritation vrith the An, the former being much 
stronger and appearing earlier than the latter. The normal formula of 
the acoustic nerve, therefore, with a moderate strength of current is: 
only Ca CI S (sensation of sound) ; with a stronger current, it is the fol- 
lowing : 

Ca CI S, loud sound. 

Ca O, nothing. 

An CI, nothing. 

An Os, feeble noise. 

The qualify of the sounds varies somewhat, but not so much in healthy 
individuals as in those suffering from ear diseases. Healthy individuals 
usually hear a more or less loud whistling or hissing, or perhaps a roaring 
or buzzing. The An O reaction is usually very feeble and short With 
increasing strength of current, the auditory sensations increase in inten- 
sity, distinctness, and duration, and assume a more musical or whistling 
character. 

We find in this nerve of special sense that the physiological law of dif- 
ferent polar action — the Ca stimulating only at closure, the An only at 
opening->is presented with remarkable precision and clearness. 

* For further details, vide BrezlDer*a book and mj articles in the Enapp-Moos' Ar^ 
ohiv f iir Angen- a. Ohrenheilkunde. 



PHYSIOLOGICAL INTRODUCTION. 49 

But we must ask ourselves why purely polar e£Eects are alone obtained 
in this nerve ? According to our previous statements, an anode is inev- 
itably present in a nerve presenting a cathode, and here, as in the motor 
nerves, we should expect, upon irritation with the Ca the action of the 
secondary virtual An. Why does this not happen in the present case ? 
Hitzig has endeavored to explain this phenomenon by the anatomical rela- 
tions (the position of the nerve in a bony canal, its direct transition into 
the brain tissue, the divergence of the acoustic fibres in ihe central organ), 
on account of which the density of the threads of current producing the 
secondary polar action will be so slight that they will be usually ineffective. 
Under pathological conditions, however, these effects (Ca O and An CI 
reaction) may develop. It is also possible that the extreme terminal ap- 
paratus of the nerve can alone be stimulated by the galvanic current, and 
that this always reacts exclusively under the influence of the nearest pole, 
while the effect of the other virtual pole only occurs at the central end of 
the nerve, which is perhaps not at all excitable, or at least not with such 
weak currents. 

With the simplest galvanic element (a piece of zinc and copper) placed 
on the tongue we can produce a peculiar, acid, salty, metallic taste, which, 
with stronger currents, readily develops upon the application of the elec- 
trodes to the cheeks, throat, temples, mastoid processes, and the neck. 
This is the so-called galvanic taste. 

More careful examination — for example, if two medium electrodes be 
placed upon the cheek — teaches that distinct gustatory sensations occur on 
both sides, i.e., at both poles, but that they are very different on the two 
sidea At the An the sensation is more marked and metallic, alkaline, or 
perhaps very acid ; at the Ca it is feebler, more biting, salty, constricting, 
and never, according to Vintschgau, alkaline. The difference is so strik- 
ing that the An can readily be distinguished from the Ca by this meana 

We also find that the continuous passage of the current is accom- 
panied by a continuous sensation, as the latter is not alone present upon 
making and breaking the current, but also during its passage, although 
it rapidly diminishes and disappears with weak currents ; when the cur- 
rent is strong, the sensations persist for a long time. Whether these sen- 
sations are due to the local action of the alkalies and acids produced by 
electrolysis, or to the stimulation of the nerves of taste or of their termi- 
nal organs, is still imdecided. 

Very little is known concerning galvanic stimulation of the olfactory 
nerve. Althaus states that, upon the passage of strong currents into the 
nasal cavity, he experienced a phosphorus-like smell, and he attributes 
this to an irritation of the olfactory nerve by the current Others suppose 
iimt this smell is due to the development of ozone (?) in the nasal cavity. 

4 



LEOTUEE VI. 

Eleotro-pbysiology of the Seoretory and Vasomotor Nerves— Gerfical Sympatiielio^ 
Effect of Electrical OarreDte on the Skin— Electro-physiology of the Bimin and 
Spinal Cord — Phenomena in Galvanization of the Brain and Spinal Cord in ICan 
— Electro-phyaiology of the Organs of the Thorax and Abdomen — ^Electroljtio 
and Cataphoric Effects — Galvanic Introduction of Drags into the Body — Remak's 
Catalytic Effects — Indirect Catalysis. 

CJoNOEENiNa the electro-physiology of the secretofy nerves we possess 
relatively little knowledge which is useful to us. In the human subject 
-very few experiments have been made. It is known that upon passing 
a galvanic current transversely through the cheeks or the anterior and 
posterior aural region, in irritation of the acoustic nerve, etc., an actiTe 
secretion of saliva occurs in the majority of individuals. It is still unde- 
cided whether this is due to direct irritation of the chorda tympani or to a 
reflex stimulation of salivary secretion from irritation of the gustatoxy 
nerves or the sensory nerves of the buccal and pharyngeal cavitiea 

According to Moritz Meyer, the application of the galvanic current in 
a certain manner to the region of the cervical sympathetic produces a local 
increase of the secretion of sweat in the corresponding half of the face and 
the hand ; Adamkiewicz states that energetic faradic irritation of the 
tibial nerve in the popliteal space causes an abundant secretion of sweat 
in the foot 

No " law of contraction of the vasomotor nerves " has yet been discoT- 
ered but a large number of almost confusing phenomena have been ob- 
served. Upon faradic irritation of the vessels, they first contract and then 
dilate after the cessation of the irritation ; if the nerves have been divided 
for some days their stimulation at once causes dilatation. Upon galvanic 
irritation with both poles, contraction and then dilatation of the vessels 
occurs, with stronger currents the dilatation rapidly ensues and predom- 
inates. According to Gruetzner, the galvanic current is a direct irritant 
for certain vascular nerves, viz., the vasodilators of the skin ; the passage 
of a constant current for a few minutes through the sciatic nerve of the 
dbg at once produces, independently of the closure or opening of the cur- 
rent, a dilatation of the vessels without previous contraction. 

The electro-physiology of the sj/mpalhetic system will detain us for a 
few moments, because this has become a matter of prime importance with 



PHYSIOLOGICAL INTRODUCTION. 51 

ii^^ard to certain therapeutic questions ; these remarks refer chiefly to the 
cervical sympathetic. 

This is a very complicated nervous structure, all of whose relations are 
bj no means known, and which is especially shrouded in darkness on ac- 
count of the interpolation of the large sympathetic ganglia with their 
problematic functions. It contains the great mass of vasomotor nerves 
distributed to certain parts ; to the integument of the face and scalp, 
partly to the brain and eye, perhaps also to the upper extremity ; it also 
contains fibres which regulate the secretion of perspiration, preside over 
the dilatation of the pupil and influence the position of the ball of the 
eye (smooth muscular bundles in the Uds and orbits, Mueller's muscle) ; 
finally, it contains fibres distributed to the heart, and who knows what 
others. 

Physiologists teach us that faradization of the cervical sympathetic 
causes contraction followed by dilatation of the vessels of the correspond- 
ing side of the head and face, increase of the mean cerebral pressure, dila- 
tation of the corresponding pupil and the orbital fissure, slight protrusion 
of the eyeball, finally acceleration of the action of the heart 

The effect of galvanization of the cervical sympathetic is much slighter 
and less certain ; many physiologists have not witnessed any effects upon 
the pupil and the vessels of the scalp, and the statements of others are 
contradictory. 

In the human subject the matter is even more compUcated, on the one 
hand on account of the deep situation of the cervical sympathetic and the 
difficulty of reaching it, on the other hand, on account of the close prox- 
imity of the pneumogastric, the carotid with its vasomotor fibres, the base 
of the brain, the cervical and brachial plexuses, the cervical region of the 
spinal cord, etc. The following phenomena have been observed : 

Upon faradization of the cervical sympathetic, dilatation of the corre- 
sponding pupil (doubtful, because perhaps due to a reflex from the skin), 
contraction of the vessels, unilateral pallor and coolness, followed by io- 
creased warmth. 

Upon galvanization of the cervical sympathetic (one pole in the pharynx, 
the other at the angle of the lower jaw ; or An upon the maqpbrium 
stemi, Ca at the angle of the jaw ; or finally, Ga at the angle of the jaw. 
An at the side of the last cervical vertebra), circulatory changes in the 
retina and corresponding half of the face and ear ; changes in the pupil, at 
first dilatation, sometimes followed by contraction ; diminution of the 
blood-pressure and the frequency of the pulse (doubtful) ; increased 
warmth and perspiration in the corresponding hand ; a tired feeling and 
dizziness (very doubtful). 

G. Fischer came to the conclusion that the effect of so-called galvaniza- 
tion of the sympathetic is due in great part to the stimulation of the vagus 
and its branches, and of sensory nerve fibres. But some observations on 



52 ELECTBCKTHEBAPBUnCS. 

pathological cases appear to prove that the cervical sympathetic may be 
directly influenced by the current ; I shall return to this subject at a later 
period. 

We will next turn our attention to the effects of electrical currents 
upon the external skin. 

The redness of the skin produced by various applications of the current 
is undoubtedly caused by dilatation of the blood-vessela 

Upon faradization of the skin with moist electrodes, only insignificant 
changes occur with a moderate strength of current ; with relatively strong 
currents there is occasionally a temporary pallor of the skin and cutis 
anserina, which may be followed by more permanent rednesa Upon ap- 
plication of the faradic brush the phenomena are more marked ; the pallor 
very rapidly subsides, and is followed by bright redness, which lasts for 
some time and then disappears .without a trace. 

Gkilvanization of the skin, even with a moderate current, vnll produce 
(in addition to the pricking and burning sensation previously mentioned) 
an intense redness at both poles, which may persist for a very long time. 
Small papules and even broad wheals are not infrequently observed at the 
point of application and the redness may persist for hours ; after repeated 
applications the epidermis desquamates. 

With stronger currents and prolonged duration, it is found that the 
two poles produce somewhat different effects. 

At the cathode you often find, in the beginning, contraction of the 
vessels and pallor of the skin, followed by a more pale, rosy redness ; the 
skin becomes infiltrated, thickened, covered with wheals, surrounded by a 
deep red rim ; upon opening the current, an intense redness remains for 
a long time at the site of the electrode. 

At the anode, an intense dark scarlet redness occurs at once ; the skin 
does not appear thickened but covered with small elevations ; after open- 
ing the circuit, the redness continues for a very long time and is followed 
by desquamation of the epidermis. 

If the current is strong, the application of a small metallic Ca to the 
skin (An in the shape of a large sponge electrode) gives rise to the pro- 
ducti^ of a small vesicle filled with opaque, strongly alkaline fluid ; after 
removal of the electrode this soon dries into a small brown scab, which 
falls off after a time, leaving a small loss of substance and a permanent, not 
infrequently pigmented cicatrix. A corresponding anodal application 
produces comparatively slight effects ; the metal electrode is blackened 
from oxidation, and the wheals which may be present give exit, if pricked, 
to an acid fluid. If the electrodes are moist and well covered, such phe- 
nomena will not ensue. However, there is no doubt that the galvanic 
current produces very m£u:ked changes in the circulation and nutrition of 
the skin, but the deeper tissues cannot be affected to such a marked 
extent 



PHYSIOLOGICAL INTRODUCTION. 53 

The physiological effects of electrical currents upon the brain haTe 
been the subject of numerous investigations. Contrary to what happens in 
the peripheral motor nerves, it bos been found that An Gl produces greater 
stimulation of the cerebral cortex than Ca 01 ; perhaps the cause of this re 
markable phenomenon is to be found in the different chemical reactions 
of the gray and white matter — ^Hving peripheral nerve fibres are alkaline 
(Funke), the gray matter of the brain acid, the white substance neutral or 
faintly alkaline (Gbcheidlen). If the currents are weak or of moderate- 
strength, the shortest possible closure of the circuit will diminish the irri- 
tability at the same pole, but increase it at the other ; changes of polarity 
cause most vigorous stimulations. The faradio current is also effective. 

Upon performing galvanization of the head, a series of very decided 
phenomena develop, but faradization of the head in the human subject 
appears to be devoid of effect 

Vertigo is the earliest and almost constant symptom when galvaniza- 
tion of the head is performed in such a manner that the largest amount 
of current passes through the brain (transversely through the temples or 
the mastoid processes, or from the forehead to the back of the neck). 
This phenomenon consists of a disturbance of equilibrium which is merely 
of a subjective nature in the mildest grades, but in the higher grades is 
rendered objective by tottering of the head and trunk so that the indi- 
vidual may even fall ; these higher grades may be accompanied by appar- 
ent rotatory movements of external objects, or by a sensation of rotation 
of the body. 

It has been ascertained that galvanic vertigo develops with so much 
more readiness the greater the angle formed by the line connecting both 
electrodes upon the skull with the sagittal longitudinal diameter ; it is 
therefore most intense when the current is passed transversely, most feeble 
when passed antero-posteriorly. 

Brenner found that, on passing the current transversely, a distinct 
sensation of vertigo occurs upon closure of the current, together with an 
objective tottering of the head toward the side of the anode ; upon break- 
ing the current, a much slighter degree of tottering toward the side of the 
cathode. The subjective feeling predominates greatly over the actual 
amoimt of tottering. 

The sensation of vertigo also continues during the passage of the cur- 
rent. Distinct apparent rotation of siirrounding objects is then associated 
with it, so that the persons experimented on fear that they will lose their 
equilibrium entirely. These rotations occur usually in a vertical plane, the 
objects appearing to pass from the side of the anode to that of the cathode, 
rising upon the former and sinking upon the latter. According to Hitzig, 
they are due to the ocular movements produced by the galvanic irritation. 

The ocular movements probably occur as the result of the severe ver- 
tigo and the disturbance of the muscular sense. 



54 ELEOTBO-THEBAPEUnCS. 

If a vigorous current is passed transversely through the mastoid pro- 
cesses, associated, nystagmus-like, oscillating movements of the eyes occur 
in a definite direction, viz. : in that of the positive current. If the anode 
is situated on the right side, both eyes vnll be directed to the left 

In addition, many persons complain, upon galvanization of the head, of 
a certain dulness, a feeling of confusion, and perhaps of threatening syn- 
cope, which may even terminate in syncope in very sensitive individuals. 
In certain cases a feeling of nausea, and even vomiting, have been noticed. 

The results of physiological experiments are much scantier vnth regard 
to the spinal cord than the brain. A few authors have investigated the 
modifying eflFects of galvanic currents upon the cord. J. Ranke found 
that the reflex irritability of the spinal cord in the frog could be dimin- 
ished or entirely extinguished by a current of a certain strength pass- 
ing through the cord in any direction. Legros and Onimus only found 
this effect witlx the descending current, the reflexes being often in- 
creased by the ascending current Finally, Uspensky thinks the spinal 
cord should be regarded electrically as a peripheral nerve which can be 
brought into an electrotonic condition by the galvanic current, and he 
found corresponding changes in the reflex irritability and the respiratoiy 
movements. 

It has been supposed that the spinal cord of the human subject cannot 
be reached by electrical currents applied in the ordinary percutaneous 
method, but this view has been disproven. Large, flat electrodes should 
be placed on the back, very strong currents employed, and closure and 
opening should be resorted to. If the Ca is situated on the upper lum- 
bar vertebrse, Ca CI or change of polarity to Ca will produce vigorous 
contractions of the muscles supplied by the sciatic nerve, thus proving 
that the current has penetrated at least into the spinal canal. In addition, 
numerous undoubted therapeutic experiences teach us that the galvanic 
current may reach the spinal cord. Nevertheless, our knowledge with 
regard to the physiological effects of electrical currents upon the spinal 
cord is almost nil 

Electro-physiological examination has been scarcely directed to the 
heart and lungs. It has been shown that a certain method of application 
of the galvanic current will cause movements of coughing, especially if the 
Ca is placed upon the back of the neck, the other upon the back, and 
closure of the current or change of polarity is then made ; in some per- 
sons, also, this will occur if the upper electrode is placed upon the dorsal 
vertebrae. 

We are somewhat better acquainted with the effects of electrical cur- 
rents upon the abdominal organs. 

It has been said that contraction of the gall-bladder, especially in 
catarrhal jaundice with very dilated gall-bladder, has been obtained by 
vigorous percutaneous faradization in the region of the organ. 



PHYSIOLOGICAL INTRODUCTION. OD 

Maay obseirers state that they have succeeded with the faradic cur* 
rent, either directly or in a reflex manner, in efifectiag a considerable re-, 
duction in the size of chronic enlargements of the spleen. Some haye 
faradized the spleen directly by means of moist electrodes, others hav» 
employed vigorous irritation of the skin in the splenic region by means of 
two faradic brushe& 

The striated muscular tissue of the pharynx and velum palati may be 
readily faradized and galvanized by means of suitable electrodes. Local 
contractions then occur, or, if the currents are strong, vigorous, wide- 
spread muscular contractions, movements of deglutition and gagging de* 
velop. If the An is placed on the upper part of the back of the neck, 
and the Ca rapidly passed over the lateral surface of the laryngeal region, 
you will see and hear a movement of deglutition vnth every Ca CI and 
short labile stimulation (with 6-10 elements). We evidently have to deal 
here with a reflex process from the sensory nerves of the pharynx and 
larynx (chiefly the superior laryngeal nerve). 

Contraction of the muscular fibres of the oesophagus can also be effected 
readily by Lieans of electrodes shaped like sounds. 

The smooth muscular fibres of the stomach and intestinal tract reaci 
to electrical currents by slow contraction, which gradually grow stronger, 
spread more or less from the site of primary stimulation in a peristaltic 
manner, and outlast the irritant for a shorter or longer period. They ap- 
pear to be less affected by the galvanic than by the faradic current. 

The effect of vigorous faradization of the abdomen (which can be ob* 
served with special distinctness in cases of large inguinal hemisewith thin 
tegumentary coverings, or in persons with very thin, flaccid abdominal 
waUs), consists of the production of visible, palpable peristaltic move- 
ments of the stomach and intestines, which sometimes cause gurgling. 
As an effect of faradization of the stomach, Schliep observed a rapid dis- 
appearance from the organ of water which had been introduced ; defe- 
cation often occurs soon after intestinal faradization. The digestive tract 
may be reached in various ways : either by percutaneous application, one 
electrode upon the back, the other stabile or slowly moving over the cor- 
respondilig portion of the abdominal wall, or by means of the introduction 
of an electrode into the stomach (either a stomach electrode proper or an 
oesophageal sound to which a wire has been attached), or into the rectum, 
the other being applied stabile or labile upon the external abdominal wall. 
The electrode, which is introduced internally, causes scarcely any sen- 
sation. 

Electrical stimulation of the bladder can be readily performed. If a 
urethral electrode is introduced as far as the neck of the bladder, the con- 
traction of the sphincter vesicae and urethral muscles upon faradization 
can be readily detected. Vesical electrization may be done with both 
currents, either percutaneously or by the introduction of catheter-shaped 



56 SLKCTUOTlLEUAPi: UTICS. 

vesical electrodes as fu* as the sphincter or into the bladder. Nothing is 
known concerning electrization of the other abdominal organa 

I now come to the consideration of the electrolytic and cataphoric 
effidcts of electrical currents ; this refers almost exclusively to the galvanic 
current, the effects of the faradic being almost nil in these respecta 

The occurrence of electrolytic processes in the animal organism have 
been distinctly proven with reference to the surface of the body alone, 
as has been shown on page 62. But concerning the effects produced 
within the economy, we possess merely surmises. A beginning has been 
made by Drechsel, who succeeded in producing urea from solutions of car- 
bonate of ammonia by electrolysis with changing currenta It is at least 
probable that this process also occurs within the living organism. On 
account of the scantiness of our actual knowledge concerning electrolytic 
effects in the human subject, I will refrain from theoretical considerations ; 
I will again recur to the subject in considering the therapeutical effecta 

Concerning the cataphoric effects we stand on a somewhat more solid 
foundation. A successful attempt has recently been made to employ the 
cataphoric action in the introduction of drugs into the body. After v. 
Bruns had shown that the galvanic current could force iodide of potassium 
through dead and living parts of the human body, Munk devised the 
most serviceable method of effecting this object. 

The elder Hemak had recognized the fact that the chief effects of the 
galvanic cvurent in disease are very complicated ; that we probably have 
to deal, in the majority of cases, with changes in the nutrition of the parts 
(molecular, chemical, histological changes). In his studies concerning 
the curative influence of the galvanic current in inflammations, contusions, 
hemorrhages, rheumatism, neuritis, etc, it became evident to him that 
these effects were perhaps direct, from change in the molecular condition, 
osmosis, etc., of the tissues, but partly also indirect, from changes of cir- 
culation and the current of nutritive fluids in the tissuea He has in- 
cluded a number of these effects under the common term catalytic action, 
viz., dilatation of the blood-vessels and lymphatics, causing more ready 
circulation of the blood and nutritive fluids, and increased absorption ; in- 
creased power of imbibition of the tissues, increased osmotic processes 
and thus increase of volume (especially in the muscles) ; changes in the 
disassimilation and nutrition of the nerves on account of their stimulation 
or sedation ; changes in the molecular arrangement of the tissues caused 
by electrolytic processes ; finally, the consequences of the mechanical 
transport of fluids from one pole to the other. 

The physiological or experimental foundation of these catalytic actions 
is still very imperfect and fragmentary. The conviction of the reality of 
these changes has forced itself upon almost all electro-therapeutists since 
the time of Hemak, on account of a large array of pathological and thera- 
peutical experiences with which you will become acquainted at a later 



PHYSIOLOGICAL INTRODUCTION. 67 

It would be Tery desirable, however, if this entire matter were 
sabjeoted to experimental investigation. 

Bemak had observed that frogs' musdes, when galvanized bj a labile 
onrrent, showed an enormous congestion, became tenser and appeared 
swollen, and he maintains that they absorb water much more rapidly than 
non.galvanized muscles. 

Furthermore, the changes described by Bemak, Bollinger, v. Ziemssen, 
and myself after galvanization of the skin are so evident that they have 
always appeared to me to constitute an important argument in favor of 
catalytic action. 

Of especial importance is the demonstration of the vasomotor effects 
of electrical currents. The recent experimental researches of Lbwenfeld 
with regard to dilatation and contraction of the cerebral vessels upon 
transverse and antero-posterior passage of the galvanic current through 
the head are valuable in this respect 

Perhaps, also, the electrical actions upon trophic nerve-tissues may pro- 
duce changes in the disassimilation of other tissues and organs of the 
body, organic metamorphoses, modifications of nutrition, which constitute 
a piurt of the ''catalytic " effiocta 



PART in. 



METHODS OP ELECTRICAL EXAMINATION AND 

ELECTRODIAGNOSIS. 



LECTURE Vn. 

The Methods of Blectrioal Examination— Examination of the Motor Nerves and Mne* 
oles — Polar Method — General Roles — Method of Qnantitative £xaminati<m of 
Irritability with the Faradic and Galvanic Cnrrents — Method of the Qualitative 
Examination of Irritability — Examination of the Eye — Examination of the Audi- 
tory Apparatus — Galvanic Examination of Taste — Examination of ElectrO'OUtan- 
eons Sensibility — Electro-musonlar Sensibility. 

Thb examination of the motor nerves and musoleB is b j ftur the most 
important ; this consists of a carefully measured and graduated stimula- 
tion of drcumsoribed parts, usually situated near the surface, viz., indi- 
Tidual nerve-trunks and branches, individual muscles and portions of 
musdea 

The chief object of examination consists in localizing the current with 
the necessary intensity and density upon these individual parts, and in 
keeping other parts as free as possible from their action. 

It follows from the laws formulated in Lecture IV. that the polar ex- 
amination is alone serviceable in examining small parts situated within 
larger conducting masses. 

The following general rules hold good in the polar method of examina- 
tion in the human subject : 

Only one pole may be employed for each irritation ; the effect of the 
other pole is not excluded, but it should be repressed as much as possible. 

The electrode employed for the local irritant effect is called the active 
or irritant electrode (electrode A) ; the other is the indifferent electrode 
(electrode B). 

The active electrode should be as small as possible, in order to seciu« 
the greatest density of current. But this has its limits, especially with re- 
gard to the galvanic current ; if the electrode is too small, the strength of 



60 £L£CTB0-TH£BAP£UTIC8. 

carrent will be diminished too much on account of the diminution in 
the transverse section of conduction and the examination thus rendered 
more difficult ; I therefore employ in galvanic examination the " small " 
or " medium " electrode. 

The indifferent electrode should be as large as possible, in order that 
the density of the current may be as slight as possible and therefore rela- 
tively ineffective. This electrode should be appHed to the most indiffer- 
ent position, and the sternum seems to me to be the best in this respect ; 
it is in the median line, the current meets with equal resistance in passing 
to symmetrical parts of the body, it passes immediately into the trunk and 
rapidly loses its density ; there are no nerves or muscles in the neighbor- 
hood whose irritation will interfere vnth the examination ; in addition, the 
sternum is quite insensible, and the person examined can readily apply the 
electrode in this position. The indifferent electrode may also be applied 
to the back of the neck, or the small of the back, but these positions are 
less serviceable on account of the vicinity of the spinal cord and roots of 
the spinal nerves in the latter case, and the head and brain in the former. 
In a few exceptional cases, however, some other localization must be 
chosen. 

One of the most important rules is that the same method of examina- 
tion should always be employed, and, if possible, the same apparatus, at 
least when the results of various examinations are to be compared with 
one another. Every observer should be skilled in the use of his own in- 
struments, and this requires great practice and technical skill. 

It is a rule of no slight practical significance, that, iii diagnostic in- 
vestigations, the examination should always begin upon the healthy parta 
Inattention to this rule not infrequently causes us to overlook slight 
disturbancea 

Method of the Quantitative Determination of the iRBiTABiiiiTT of 

Nerves and Muscles. 

This examination may be made vnth regard to both forms of current. 

The following was the method of faradic examination formerly in 
general use and also largely employed at the present time ; a careful de- 
termination was made of the amount of withdrawal of the cylinder at 
which the minimum muscular contraction occurred (upon irritation of the 
motor nerves or direct musciilar irritation), or the contractions occurring 
in symmetrical pc^rts were compared with one another, the strength of 
current remaining the same (equal withdrawal of the cylinder). 

This method would be very good if, apart from the variable amount of 
withdrawal of the cylinder, all the other conditions of the examination 
remained constant 

But this occurs, as a rule, only in imilateral diseases, upon comparing 



ELECTBIGAL EXAMUTATION AND ELECTRO-DI AG N08I8. 61 

perfectlj symmetrical parts of one and the same individual. This method 
is, howeyer, entirely uncertain in bilateral diseases, in which compaiison 
most be made with other healthy individuals. It must be remembered 
that there are great differences in the resistance to conduction in various 
individuals (vide Lecture lEL, p. 23). 

We must therefore lay down the principle that the resistance to con- 
duction should also be tested ; only when this is found to be similar can 
we draw any useful conclusions with regard to the presence of differences 
in the electrical irritability. 

In order to free this examination still further from comparison with 
other individuals, I have endeavored to develop another method of 
examination. 

The purpose of this is to determine the irritability of the nerve-trunks 
in various parts of the body (head, trunk, upper and lower limbs) and then 
compare them vnth one another in healthy persona In fact, a quite 
constant relation of the four principal parts of the body was determined, 
and any considerable deviation of one or another of these pairs of nerves 
from this relation may be regarded as pathological It is therefore 
possible to recognize pathological changes of irritability by the exclusive 
examination of the patient 

As a matter of course, it was necessary to determine the resistance to 
conduction in all the parts examined. It was found that this presented 
quite a constant relation in healthy individuals ; only under the assumption 
that the relation of the resistance to conduction is approximately normal 
can the relative values of the irritability be properly estimated. If the 
relation of the resistances to conduction varies in the same manner as the 
withdrawal of the cylinder, the conclusions with regard to the irritability 
become more certain ; if it varies in the opposite manner, the conclusions 
become more uncertain or may be entirely negatived. 

The following method should therefore be employed : in the examina- 
tion the following four nerves or nerve-branches on each side are chosen ; 
the frontal branches of the facial nerve at the temple (Fig. 28), the spinal 
accessory nerve in the neck (Fig. 28), the ulnar nerve above the elbow 
joint (Fig. 29), and the peroneal nerve above the head of the fibiila in the 
popliteal space (Fig. 33). We now determine the amount of withdrawal 
of the cylinder at which the minimum contraction, i.e., the feeblest 
distinctly perceptible contraction, is obtained. These numbers are then 
noted. 

With a " medium " electrode, well moistened in warm water, we then 
determine the amount of deflection of the needle of the galvanometer 
which occurs with a definite number of elements (10 to 12) and with sta- 
bile action of the current upon all the localities previously employed 
for stimulation. I usually employ the Ca for the site of irritation, the 
An remaining on the sternum. The figures thus obtained are also noted. 



C2 



ELECTRO-THERAPEUTICS. 



We thus obtain two series of figures, one of which represents the rda- 
tive condition of the faradic irritability of the four pairs of nenres, the 
other the relative condition of the galvanic resistance to conduction at tka 
corresponding regions of the skin on each side. I have shown above how 
the results obtained in the second series complement the conclusions 
drawn from the first series. Both series present a quite constant relation 
in healthy individuals of approximately similar physique and position in 
life, and in the same sex. I append two illustrations in healthy in- 
dividuals : 

1. Healthy man ; artisan ; thirty-eight years old : 



Frontal nerve 

Spinal accessory nerve . . . 

THnar nerve 

Peroneal nerve 



Withdrawal of o^lind«r in 

millimetrea. Minimum oon- 

traction. 



right 165 
right 172 
right 150 
right 160 



left 166 
left 177 
left 158 
left 163 



Deflection of galranometer, 
with ten elements, 150 C CL 



right 18° 
right 16° 
right 6° 
right 7° 



left 19° 
left 15° 
left 6° 
left 9° 



2. Healthy man ; laborer ; twenty-four years old : 



Frontal nerve 

Spinal accessory nerve 

Ulnar nerve 

Peroneal nerve 



right 195 
right 187 
right 175 
right 180 



left 192 
left 182 
left 185 
left 180 




left 17° 
left 9° 
left 10° 
left 5° 



These tables are valid for my apparatus alone ; but, although the abso- 
lute figures may vary for other apparatus, their relative proportion will 
not vary. 

After having collected a large number of these tables, I have found 
that the figures are almost exactly the same for both sides of the body, 
that the four pairs of nerves are irritated by almost the same minimum 
strength of current, the dififerences being rarely more than 20-25 mm. 

The relation of the resistances to conduction is somewhat different ; the 
spinal accessory presents less resistance than the ulnar and peroneal, and 
the frontal nerve still less. There are so many variations in women and 
children, especially on accoimt of the varying development of the pannicu- 
lus adiposus, that I do not consider it practicable to determine the normal 
formula for them. That mentioned above refers to healthy laboring men 
in middle age. 

If the faradic examination of individual nerves is desired, and not a 
general examination, this is done by careful comparison with the healthy 
sido or with other healthy individuals, all the precautions being taken to 



ELEOTBIOAL BZAMINATION AND SLBOTBO-DIAONOSIS. 63 



which I hsTe previouslj referred. In order to prevent miBtakes^ repeated 
examinations should be made in all important or doubtful eases. 

in quantitative galvanic examination of irritability greater precautions 
must be observed than in the faradic examination. A statement of the 
number of elements employed, or the resistance experienced in a rheostat 
is only sufficient to a certain extent in comparing both halves of the body 
of one individual ; it is useless for comparison with other individuals, on 
aoeount of the remarkable di£ference of the resistance to conduction in 
different persons (Lecture lEL, p. 28). 

The first requisite in the determination of fine quantitative di£ferenoes 
is that the nerves and musctes to be compared should be examiued with 
the same density of current This depends, on the one hand, upon the 
size and surface of contact of the electrodes, on the other hand, upon the 
strength of the current The same electrodes should therefore always be 
employed in the examination. In addition, the strength of the current 
should be determined at any period of the examination by means of the 
galvanometer. If the electrodes are alike, and the strength of the current 
is accurately determined, we may be certain that if the deflection of the 
needle be the same, the same density will be present under the active 
electrode. In addition, the latter should be placed upon the parts to be 
compared in exactly the same manner and position, and with the same 
degree of pressure. If, when these conditions are fulfilled, the deflection 
of the needle necessary to produce a minimum contraction increases, 
then the irritability is diminished ; if the requisite deflection of the needle 
diminishes, then the irritability is increased. 

One of the most important sources of error in this mode of examina- 
tion is due to the fact that the position of the nerves at the surface of the 
body is somewhat variable. 

The indifferent " large " electrode should be placed upon the sternum, 
the active "medium" electrode is carefully placed upon the nerve or 
musde ; we then determine when the first Ca CI develops, beginning 
with a small number of elements ; the galvanometer is then introduced 
and the amount of deflection of the needle noted. The strength of the 
current is then increased still further, three cathodal closures being made 
at each stage, until that strength of current is reached at which Ca Gl Te 
appears ; the deflection of the needle and the number of elements is then 
again noted. 

If we have an opportunity for comparison with synmietrical healthy 
nerves, slight di£ferences of irritability may be determined with great cer- 
tainty. This is much more difficult when we must institute a comparison 
with other individuals. In order to avoid this as much as possible, we 
may examine the four pairs of nerves of different parts of the body, as has 
been previously explained with regard to the faradic current. The f<^ow« 
^ing table will serve as an illustration of the results thus obtained : 



64 



XLBOTBO/rHBSAPBTTTIOS. 



Healthy man ; artiaan, thirty-eight years old : 



Nerrai. 



Right frontal nerve. . . 
Left frontal nenre. . . , 
Right accessory nerre 
Left accessory nerve. , 
Right ulnar nerve. . . , 
Left ulnar nerve .... 
Right peroneal nerve . 
Left peroneal nerve . 



AppeanDoe of fint 
%»aCwith 


with 


of fin* 
CAW-) 


8 elemeDts 16° 


12 elements 32° 


6 « 18° 


10 




29° 


6 « 7° 


12 




29° 


6 « 8° 


12 




81° 


6 « 5° 


U 




28° 


6 « 6° 


14 




27° 


8 « 7° 


14 




29° 


8 " 8° 


12 




28° 



The frontal nerve, however, presents a very variable relation, and I there- 
fore think it more practical to exclude it, as a rule, from the examination. 

The strength of current at which An CI C, An O C and Ca O C de- 
velop in the various nerves may be examined in a similar manner. 

In addition to the quantitative examination of the irritability, you 
should also ascertain whether any anomalies of the law of contraction, etc., 
are present. I will therefore add a few words vnth regard to the 

Mbthod of thb Qualitativb Determination op the Ibritabilitt or thr 

Nebves and Muscles. 

No qualitative determination of irritability with the faradic current 
has yet been obtained. This examination with the galvanic current plays 
a prominent part in electro-diagnosis. 

The question with which we have to deal is the determination of the 
law of contraction of each individual nerve or muscle ; we must observe 
whether the contractions appear in the proper manner, present the ordi- 
nary strength, and are unchanged in form and duration. In general the 
same method is to be employed as in the determination of the law of con- 
traction, i.e., the polar method, with the previously mentioned precautions. 
It is especially important that you should be well informed with regard to 
the peculiarities of each nerve of the body, as these may deceive the be- 
ginner. Especially important with regard to the muscles is the examina- 
tion of the mode of contraction, its rapid or slow occurrence, the predom- 
inance of one or the other factor of irritation. In doubtful cases it is 
well to compare the corresponding muscle of healthy individuala 



(( 



Method op Examination op the Eye. 

The polar method is strictly employed, the active *' medium" or 
small ^ electrode being placed upon the closed lids (or upon the temple 



BLSOTBIOAL XXAMIKATION AND ELS0TBO-DIAGKO8IS. 65 

or forehead), the indifferent " hurge " electrode dodng the drcoit upon 
the sternum. It has also appeared to me to be useful to apply the indif- 
ferent electrode upon the back of the neck. The examination of each eye 
is then made in Ihe usual manner with regard to Ca CI and Oa O, An CI 
and An O. Four, six, or, at the most, eight elements are usually suffi- 
cient. The examination is rendered easier if made in a half-darkened 
room, the eyes being kept dosed. 

On acoountof the very great irritability of the retina it is often difficult 
in cases of unilateral disease to prevent the diffusion of the current to 
the other eye. In such cases the indifferent electrode should be applied 
as a " small " electrode to the corresponding temple, the irritant electrode 
(also " small ") to the dosed lid. 

Method of Examination of thx Ear. 

Brenner first employed the polar method of examination whidi I haye 
preriously described. I have changed this method somewhat ; the irri- 
tant dectrode, a *' medium" well-moistened one, is applied directly in 
front of the ear so that it covers the entire tragus and presses it slightly 
inward without ocduding entirely the auditory canaL The indifferent 
electrode may be applied to the sternum ; nor is it inadvisable to apply it 
to the hand of the same side. We will effect our object most readily, how- 
ever, by applying it to the back of the neck, partly on account of the slight 
resistance to conduction at this place, partly on account of the more 
favorable direction of the densest threads of current I have previoudy 
explained in detail the manner in which the examination should be con- 
ducted. 

IVttience and considerable practice are essential requisites ; repeated 
dttingB are often necessary to accustom the patients to the various dis- 
agreeable auxiliary effects. We should begin with weak currents and in- 
crease the strength very gradually ; the occurrence of Ca CI reaction is 
especially fiunlitated if we have previoudy allowed Ca D to act ; the more 
rapidly Ca CI and An O follow one another, the more actively will Ca CI 
act The production of An O reaction is facilitated by long duration of 
doBure ; it is most readily obtained if we gradually increase to the 
greatest strength of current tolerated during An D and then suddenly 
open the drcuii 

Mbthod of Examination of Tastb. 

The poles may be placed upon the cheeks and the current allowed to 

pass transversely through the buccal cavity ; the person experimented 

upon should then describe the sensations of taste occurring upon the two 

sidea The polar method is also useful for more localized examination. A 

6 



66 ELEOTBO-THBBAPBimCS. 

*'&ne** q>onge electrode, provided with an interruptor, is plaoed upon 
Tarious parts of the tongue, pharynx, cheek, eta, and Ga CI and Ga D, 
An CI and An D then tested. 

Neumann has devised a serviceable method of examination ; the two 
well-isolated pole wires are fastened to an elastic catheter or a glass rod in 
such a manner that both ends, which are provided with small buttons, 
project at a distance of 2 to 3 mm. from one another. Armed with one 
or two elements this double electrode serves admirably to carefully localize 
the sensations. 

ElECTRIOAL EXAIONATION OF THE SeNBIBILITT OF THE SkUC. 

It has not always been borne in mind that the application of electrical 
currents to the skin tests two factors ; first, the electrical irritability of 
the nerves of the skin and their terminal organs, i.e., the law of sensory 
contraction ; secondly, the reaction of the skin as a sensory organ to the 
electrical irritant, which produces a specific sensation. 

It is a question whether it is justifiable to test the " absolute sensitive- 
ness '' of the skin by means of electricity, and to employ this as a measure 
of the degree of its sensorial irritability. The skin, regarded as a sensory 
organ, cannot be tested with irritants other than those adequate to it, 
viz., touch, pressure, various temperatures, and the higher grades of these 
irritants which produce pain ; it may be disputed whether electricity should 
be included among these " adequate " irritants of the skin. In &ct, the 
electrical sensation is a specific, distinct quality of tegumentaiy sensi- 
biliiy, whose careful examination, however, is of value in many morbid 
conditions. 

I have previoudy shown (Lecture VL, page 44) how the electrical 
irritability of the nerves of the skin and their terminations can be tested 
with the faradic and galvanic currents. 

The attempt has been made to recognize finer disturbances of sensa- 
tion, chiefly by means of the faradic current 

Leyden first described such a method ; by means of two blunt points 
of a compass, which are situated one centimetre from one another, the sec- 
ondary faradic current is introduced into the skin, and then the vdthdrawal 
of the cylinder, at which a minimum electrical sensation occurs at various 
parts of the surface of the body, is determined. From the series of figures 
which he thus obtained Leyden drew the conclusion that the absolute 
sensibility presents but moderate differences at various parts of the sur- 
face of the body. 

Upon employing this method, however, I have by no means obtained 
such a smooth series of figures as Leyden, and this fact appears to me to 
be due to faults in the method itself. Slight moisture of the skin, per- 
spiration, etc, cause the results to vary ; and finally, the resistance to 



DLBOTBIOAL EZAHIIVATION AND BLEOTBO-DIAONOSIS. 67 

ooii<3actioii haa been entirely OTerlooked. I have long sinoe disoarded 
this methc»d as unprocticable ; and I may say the same of Bemhardt's 
plan of testing the sensation to pain with the galvanic current 

I have, therefore, endeavored to devise a more serviceable method of 
testing the farado-cataneous sensibility. 

Electrode B, large and moist, is always placed upon the Btemnm. I 
employ an irritant electrode, which, like the bruBh, haa the advantage of 
Domerous pointa of entrance of the current into the skin, but avoids 
the disadvantage of the mechanical action of the individual threads 
of the brush. A bundle of more than four htmdred fine, insulated, and 
varnished metal wires are enclosed in a 
hard rubber tube about two centimetres in 
diameter, firmly adherent at one end to 
the handle of an electrode (Fig. 20, a) ; 
the other free end is as smooth as pos- 
sible, BO that it produces the seDsation of ^ 
a perfectly smooth metaUio siir&ce upon 
being placed on the eldn. Upon being 
applied to the surface, this covers a circle 
of akin two centimetres in diameter, into 
which about four hundred threads of cur- 
rent enter st the same time. We thus 
exclude all possible sources of error 
(sweat-dnots, hair-foUicles, small nerve- 
twigs, eto.) and are independent of slight 
changesinthepositionofthe irritated spot bnd<Kntu»iu HDnMUtT. a.bkrdrabbw 

This electrode (connected with the Ca «<- 1 ». »«»«*«• »"^ •'«»™'* 
of the opening current) is then applied with moderate firmness to the in- 
tegument ; the cylinder being now gradually withdrawn, we ascertain its 
position when the first minimum electrical sensatioo occurs ; the cylinder 
is then withdrawn more rapidly until the individual experiences a distinct 
sensation of pain, and the amount of withdrawal of tlie cylinder is again 
noted. 

The examination is then repeated upon as many parts of the body as 
is desired. In addition, it appears to me to be necessary to determine 
the resistance of the akin to galvanic conduction, in order to be able to 
control the results of the examination due to deviations in the former. 
Numerous experiments on healthy persons give approximately the follow- 
ing averse figures for the various parts of the body. (See Table, p. 68.) 

Very little remains to be said with regard to the examination of the 
electro- muscular sensibility Of late this has almost foUen into oblivion, 
and it is certainly by no means so readily tested as is often supposed. 

Hie examination is made by causing more or less vigorous contrac- 
tions of the individual muscles with the Cradle current, by irritation of 



68 



ELECTBO-THEBAPBUnCS. 



their nerre-tronks or motor points, and then directing attention to the 
sensation of tension and contraction, increasing to pain, which oooors in 
the musdei^ On account of the coincident iiritation of the sensory 
nerves and the skin it is not always ea^ to distinctly recognize this sen- 
sation ; the examination is therefore certain and simple in those cases 
alone in which anffiwthftsia of the skin is present 



Pomtofinitation. 


Minimnm. 


P^ 


Deflection of noedk 
witbSBLUtOaK 


Oheek 


200-220 
180-200 

200 

190 

176 

126 

190 

180 

170 

176 

110 


130 
120 
120 
116 
110 

90 
120 
116 
110 
110 

80 


26» 


Neck 


22» 


Arm 


21' 


Forearm 


18« 


rv>nmm of hand ...•••..... 


16' 


Tips of finsrers 


2» 


Abdomen 


20' 


Tbiffh 


2V 


****o'* •••••••••••••••••••• 

Calf 


19" 


Dorsum of foot 


10» 


Sole of foot 


6» 







lECTUEE Vm. 

PAtliologioal Cluages of Eleotrioal Irritability and their Diagnoatio Signifioanoa—A. 
Eleotro-diagoosis of the Motor Nenres and Mnaolea^l. Increase — 2, Diminution 
of Eleotrioal Irritability — 8. Degeneration Reaction— Deaoziption of De R. — Ite 
Ck>nr8e— Inoreaaed Meohanioal Irritability. 



A. CHANOES IN THE ELEOTRIOAL IRRITABILITY OF THE MOTOR 

NERVES AND MUSCLES. 

Both quaiititaiiye and qualitatiye changes occur, the latter especially 
in the muscles, and rarely without the coincident occurrence of the former. 
The reaction of the nerves and muscles to the faradio and galyanio current 
is parallel in many cases, in others it is totally divergent. 

L InGBBASB of ElBGTRICAL iBBrrABHITT. 

The pathological increase of irritability, with regard to &radio exam- 
ination, is characterized by a more ready reaction of the nerves and mus- 
cles to the current ; by an increase in the amoxmt of withdrawal of the 
cylinder at which the minimum contraction occurs, or by increased inten- 
sity of the contraction occurring upon equal withdrawal of the cylinder. 
The following table iUustrates increased ffuudic irritability of the peroneal 
nerves in a relatively recent case of ataxia : 



Frontal nerve 

Spinal accessory nerve. . . 

Ulnar nerve 

Peroneal nerve 



Withdrmwal of cylinder in 

milliinetreB. Bfinimom oon- 

traotion. 



right 170 
right 166 
right 170 
right 205 



left 168 
left 167 
left 165 
left 200 



Deflection of galvanometer, 
ten elements. 150 C. R 



right 24° 

right ir 
right 6° 
right 7° 



left 24^^ 
left 18° 
left 6° 
left 8° 



The results are still more evident if the increase of irritability is 
unilateral. 

With regard to the galvanic current, simple increase of irritability is 
characterized by the occurrence of the first Ca CI C, with a less strength 
of current ; the rapid transition of Ca CI C, with a slight increase in the 



70 BLB0TB0-THBRAPEUTIC8, 

streDgth of current, into Ca D C (tetanus) ; yery early appearance of An 
O C ; finally, the occurrence of An O Te as the highest degree of intensity. 

In many cases the increased irritability is distinctly shown by a strik- 
ing disproportion between the motor and sensory reaction, ie., yery yig- 
oroos contraction with yery slight sensation and without any pain. In 
simple increase of irritability qualitatiye changes of importance are absent. 

A case of tetany, in which the following results were obtained, will 
serye as an illustration : 

In the radial nenre : 

First Ca a C with i"" deflection of needle (normally, 3""). 
First Ca D G with 3"" deflection of needle (normally, lO""). 

In the ulnar nerye : 

First Ca CI C with i* deflection of needle (normally, 6**). 
First Ca D C with 3^"" deflection of needle (normally, 10-11''). 

In this patient An O tetanus was obtained with fourteen elements ; 
in a healthy indiyidual, with a similar resistance to conduction, this can- 
not be produced with 24 to 26 elements. 

The determination of these quantitatiye changes of irritability occurs 
with the greatest facility in unilateral affections, in which a compariscm 
may be made with the corresponding healthy parts ; when this is not the 
case, the directions preyiously laid down for exact quantitatiye determina- 
tion of irritability hold good. Such changes can then be readily and 
poaitiyely ascertained. 

Occurrence. — Simple increase of electrical irritability is, on the whole, 
a rare phenomenon, and possesses no great diagnostic importance ; per- 
haps it would be found more frequently if a careful quantitatiye examina- 
tion were more often made. 

It has been obseryed, in a moderate degree, in some forms of cerebral 
fwralysis, in hemiplegias of yarious kinds and not too long standing, 
especially in those associated with motor-irritatiye symptoms (contrac- 
tures) ; more rarely in some spinal affections, for example, in the initial 
stage of locomotor ataxia, perhaps also in some neryes in recent cases of 
progressiye muscidar atrophy ; but all these statements require more 
careful inyestigation. Finally, it is somewhat more frequent in certain 
forms of peripheral paralysis, usually only for a short period at the be- 
ginning, though sometimes for a longer time ; for example, in recent 
cases of rheumatic facial paralysis (£rb, Brenner, Beyer), also in paralysis 
of the radial nerye from compression (Bernhardt), and in recent neuritis. 

But the occurrence of increased electrical irritability is more interest- 
ing and important in certain forms of spasm. I first demonstrated this in 
a case of tetany, in which the occurrence of An O tetanus was especially 
well marked. I haye since obseryed this condition in all cases of tetany 
which haye come under my notice, and this has been corroborated by 
other obseryers. In my first cases the increased irritability was confined 



ELECTRICAL EXAMINATION AND ELECTRO-D AGN0SI8. 71 

to the nerves of the trunk and eztremitie8» but others have also found it 
in the facial nerve. It is also said to occur in recent cases of chorea 
minor, but I have not succeeded hitherto in verifying this statement. 

2. DnciNnnoN of Elbctbioal iBBirABtLmr. 

With regard to the faradic current, this is characterized by a diminu- 
tion in the amount of withdrawal of the cylinder necessary to the produc- 
tion of a minimum contraction, or by a distinctly feebler character of the 
contractions with stronger currents ; the diminution of irritability may 
increase so that progressively stronger currents are required to produce 
contraction. If the strongest currents which can be employed produce no 
contraction we speak of " the extinction of faradic excitability." Strictly 
speaking, this is at first true of percutaneous stimulation alone ; feeble 
contractions can often be produced for a long time in the exposed mus- 
cles, or by means of electro-puncture. It is especially evident in uni- 
lateral diseases when a comparison can be made with symmetrical parts. 
The following will serve as illustrations : 

1. Progressive musctUat atrophy, most marked on one side : 

Heftlthy side. Diseased side. 

Ulnar nerve 130 mm. 110 mm. 

Median nerve 166 " 188 " 

Peroneal nerve 140 " 106 " 

C B the same on both sides. 

2. Case of true muscular hypertrophy of the left leg. (O. Berger, Oase 
L) Diminution of faradic muscular irritability : 

Quadriceps right, 96 mm. ; left, 60 mm. 

Vastus extemus " 100 " " 36 " 

Gastrocnemius " 87 " " 16 " 

Tibialis anticus " 106 " « 66 " 

But even moderate diminution of faradic irritability may also be de- 
termined in bilateral affections. 

3. Case of locomotor ataxia ; man aged thirty-seven years : 

Frontal nerve right, 170 mm. ; left, 166 mm. ; 10° C R 

Spinal accessory nerve . " 176 " " 180 " 8° «* 

Ulnar nerve '* 176 " " 186 " 2° " 

Peroneal nerve " 132 " "142 " 1^° " 

Therefore diminution of faradic irritabOity in the peroneal nerves. 

In some cases, also, the diminution of faradic irritability is very evi- 
dent in different parts of the same nerve, for example, in the nerves of the 
arm at the elbow compared with the wrist Thus, for example, in pro- 
gressive muscular atrophy : 

At the elbow. At the wriit 

Median nerve 168 mm. 113 mm. 

Ulnar nerve 166 " 123 " 



72 ELECIRO-THEUAPEUTICS. 

In another case I obtained the following results : 

Atthealbow. Atihewriirt. 

Median nerve 155 mm. Extinguished. 

Ulnar nerve 176 " " 

It is self-evident that we cannot conclude positively that the same fibres 
are irritable at the elbow, but non-irritable at the wrist, although such a 
condition is possible. In many cases we may only conclude that the cen- 
tral portion still contains a number of irritable fibres, but the peripheral 
part does not Which of these two interpretations is correct vrill be ascer- 
tained by careful observation of the muscles which are to be contracted. 

With regard to the galvanic current, diminution of excitability is first 
expressed by the occurrence of the minimum Ca CI C with a greater 
strength of current ; a disproportionately great strength of current is 
necessary to produce Ca CI Te ; finally the reactions gradually disappear ; 
at first Ca O C is no longer possible, then An CI C and An O C diminiBh 
and disappear ; very soon Ca D C can no longer be produced, so that 
finally Ca CI C alone remains with a very great strength of current. If 
this can no longer be obtained (even vnth a change of polarity) we speak 
of extinction of galvanic irritability. 

This is the usual course of events in simple diminution of galvanic irri- 
tability in the nerves ; there are no qualitative changes of the law of con* 
traction or the mode of contraction. The latter is always short and 
lightning like, not slow and long drawn out This is also true of the 
muscles, but only in a portion of the cases ; in another part, qualitative 
changes also occur. Then the extinction of the contractions follows a dif- 
ferent order, finally An CI C alone remains and the contractions are slow 
and long drawn. But this forms part of the degeneration reaction, which 
will soon engage our attention. 

I will first give a few examples of unilateral affection of the nerves and 
muscles: 

1. Pressure paralysis of the right radial nerve (middle form) : 

First Ca a C : right at 22^ ; left at 10° deflection of needle. 
First Ca D C : right at 34° ; left at 31° deflection of needle. 

2. Atrophy of left quadriceps from inflammation of knee-joint 
(Bumpf ) : 

(CaaC -^-^^ >.o.i.^ no 

Crural nerve •<AnClC 

(AnOC 



right, 4° ; left, 7' 
" 6° " 12° 
« 31° « 37° 



8. Encephalopathy ; left hemiparesis : 

Ca a C : right, 8 EL, 6° 
" 14 El., 28° 
" 4 EL, 3° 
" 10 EL, 26° 



( Ca CI C 
"Olnx^rierve jcaDC 

J, , ( Ca CI C 

Peroneal nerve. • • ■) Ca d c 



lefl^ 10 EL, 16^ 
" 18 EL, 36°. 
" 10 EL, 19 
" 18 EL, 38 



o 



SLEOTBIOAL EXAHINATION AND ELECTBO-DIAONOSIS. 73 

Thorough examination also gives satisfactoiy results in bilateral dis- 
eases. 

1. Locomotor ataxia : 

Ulnar nerve Ca a C, e"* ; Ca D C, SO"*, 

Peroneal nerve Ca CI C, 20*" ; Ca D C, 40^ 

2. Spastic spinal paralysis ; man aged thirty-five years : 
Right frontal nerve Ca CI C, 10' 



Bight spinal accessory nerve . . Ca CI C, 4' 

Bight ulnai- nerve Ca CI C, 2' 

Left ulnar nerve Ca CI C, 3' 

Bight peroneal nerve Ca CI C, 17° 

Left peroneal nerve Ca CI C, 23' 



Ca D C, 36^ 
Ca D C, 36^ 
Ca D C, 35^ 
Ca D C, 41^ 
Ca D C, 46°. 



These two cases show diminution of galvanic irritability in the peroneal 
nerves alone. 

Occurrence, — Simple diminution of electrical irritability occurs very 
rarely in cerebral paralyses and only in a very slight degree ; at all events^ 
it only occurs in such cases, as a rule, after the disease has lasted for 
many years, and the integrity of the electrical irritability is justly regarded 
as characteristic to a certain extent of cerebral paralysis and as a valuable 
aid in diagnosis. 

In bulbar paralyses (especially chronic progressive bulbar paralysis) 
diminution occurs frequently in the nerves as well as in the muscles ; the 
latter often present the degeneration reaction. 

In certain spinal affections a simple diminution of electrical irritability 
is not infrequently observed ; thus, to a moderate degree in old cases of 
locomotor ataxia, in spastic spinal paralysis, in cases of chronic myelitis 
and multiple sclerosis, in the spinal affections of general paresis, in uni- 
lateral spinal lesions upon the paralyzed side, etc. Even higher grades of 
diminution are sometimes observed in connection with the simple atrophy 
of muscles, which is due to their inaction. 

Perhaps this also includes the cases of acute ascending paralysis, acute 
myelitis, and other spinal affections in which a rapid and marked decrease 
of faradic and galvanic irritability has been observed. 

In progressive muscular atrophy, simple diminution of electrical irrita- 
bility in the nerves and a large part of the muscles can generally be alone 
determined, especially in those obscure forms which begin in early child- 
hood and drag their weary course for years ; in the typical form, on the 
other hand, degeneration reaction is found in a portion of the muscles. 

In peripheral affections it must be remembered that those parts of the 
nerve situated centrally from the lesion cease, upon the occurrence of par- 
alysis, to be open to examination, i.e., they appear inexcitable imder all 
circumstances, because they are deprived of connection with the muscles 
to which they are distributed, and can therefore not manifest their irrita- 



< 4 ELEOTBO-THERAPEUTIOS. 

bility. It is oharaoteristio of peripheral paralysis that the portion of the 
nerve situated on the proximal side of the lesion is entirely inexcitable to 
the faradic and galyanic currents, and this can be often employed to secure 
more accurate localization of the cause of the paralysis. 

You must be very cautious in assuming a simple diminution of elec- 
trical irritability in the peripheral portion of the nerve ; as a rule, it occurs 
only as a part-symptom of the degeneration reaction, which is manifested 
in the nerve as diminution progressing to complete extinction of the fara- 
dic and galvanic irritability ; in the musdes, on the other hand, as dimi- 
nution and loss of faradic irritability, while the galvanic excitability passes 
through an entire series of quantitative and qualitative changes, terminat- 
ing in complete extinction. In rare cases of certain peripheral paralysis, how- 
ever, simple diminution of electrical irritability has been alone observed. 

In an entire series of diseases of the muscles, also, their electrical irri- 
tability is simply diminished to a greater or less extent without any quali- 
tative changes. TMs occurs, as a rule, in the rare cases of true muscular 
hypertrophy, and to a still greater extent in so-called pseudo-hypertrophy 
of the muscles, in which the. greatly diminished electrical irritability 
stands in striking contrast to the colossal size of the muscles. But practi- 
cally and diagnostically this is much more important in the very frequent 
atrophy and paralysis of the muscles as a result of joint diseases (shoulder, 
knee, etc. ). Qualitative changes of paralysis are always absent in such cases, 
and this is very important in the differentiation from degenerative atrophy. 

Seeligmueller has recently described some cases of arsenic paralysis, in 
which the faradic and galvanic irritability was very markedly diminished 
without any degeneration reaction. Da Costa* makes a similar statement. 
We not infrequently meet with cases of old paralysis, atrophy eta, in 
which examination merely shows more or less diminution of irritability ; 
but it is then difficult or impossible to decide whether we do not have to 
deal with the terminal stage of the degeneration reaction. 

At all events, the diminution of electrical irritability possesses a certain 
diagnostic significance, and especially the slighter grades appear capable 
of facilitating the diagnosis •f certain (particularly central, spinal) affec- 
tions, of excluding simulation, etc. In several medico-legal cases I have 
thus succeeded, by a careful quantitative electrical examination, in deter- 
mining the almost solitary positive fact which indicated the actual exist- 
ence of disease, and thus securing justice to the patient 

S. The Deoenebatiok Beaction (Db B). 

TTnder this term, which was first employed by me, is understood an en- 
tire cycle of quantitative-qualitative changes of irritability, which occurs in 
the nerves and muscles under certain pathological conditions, and presents 
intimate relations to certain histological degenerative changes occurring in 



BLBOTBIOAL EXAMINATION AND BLBOTRO-DIAONOSIS. 75 

these structares. It is characterized in the main by diminution and loss 
of the faradic and galyanio irritabUiiy of the nerves, and the fturadic irri- 
tability of the muscles, while the galvanic irritability of the muscles per- 
sists, is sometimes considerably increased, and is always changed qual- 
itatively in a definite manner. 

Clinical observation teaches that the De B is not always completely 
developed, but that there are also cases in which it is, so to speak, re- 
stricted to the muscles, the nerves being more or less spared (partial 
De B). I vnll first give a detailed description of the complete De R 

The most important fact is that the course of the changes in the irrita- 
bility of the nerves and muscles is entirely different. 

After the action of a paralyzing lesion the motor nerves present, in 
rare cases, a slight increase of electrical irritability, which continues for a 
short time (one to two days) ; as a rule, however, a continuous diminu* 
tion of the faradic and galvanic excitability begins immediately or very 
soon after the development of paralysis (second or third day). It is com- 
pletely extinguished by the end of tbe first week or during the second, so 
that, at least by percutaneous stimulation, no contraction can be produced 
by the strongest faradic and galvanic currents. The diminution begins at 
that portion of the nerve situated nearest to the lesion, and spreads quite 
rapidly toward the periphery. In this respect the nerve reacts almost 
entirely alike to both forms of current. 

This absolute inexcitability continues for a variable period ; for a very 
short time in mild cases, for many weeks and months in obstinate cases, 
and permanently in incurable ones. 

Then the first traces of fetuming irritability to both currents appear 
at the same time, when the restoration of the lesion and the regeneration 
of the nerves have progressed to a certain extent These traces are first 
observed in that portion of the nerve situated next to the lesion, pro- 
gress very gradually toward the periphery and increase very gradually ; 
this holds good for both currents alike. In severe cases the irritability 
remains less than normal for a more or less protracted period, and, in 
such cases, voluntary motion is sometimes completely restored, while the 
electrical irritability of the nerves still presents an undoubted diminution. 

In such cases you may usually notice that the inexcitability of the 
nerves continues at a period when voluntary movements can be produced, 
t.e., a return of mobility, despite continuous loss of electrical irritability, 
and that the increase of voluntary motion occurs more rapidly than that 
of the electrical irritability. This simply indicates that the nerve vrill con- 
duct the stimulus of the will, but is not excitable by the electrical currenta 

This striking phenomenon is explained by the fact that the conduc- 
tivity and electrical irritability of the nerves are two separate qualities. 
As soon as the central and peripheral parts of the nerve have reunited at 
the site of lesion, and a certain stage of regeneration has appeared in the 



76 KLECTBO-THXRAPEUnOS. 

peripheral portion, the motor paths are capable of coDdnction, bat tbej 
are cot ^et excitable by electrical currenta ; for this purpose the regener- 
atioD must have proceeded farther. If, in the accoropaiiTing illnatration 
{¥ig. 21) of such a motor cerre, the aite of leBion situated between 6 atid 
c haa beeo regenerated, a conduction of the stimulus coming from a to the 
muscle ia again possible, although the part below c ia still electrically in- 
excitable. If the electrical stimulus is applied below c no contraction fol- 
lows, if applied above 6 distinct contractions follow ; as the stimolua of 
the will acta above b, it will also give rise to muscular con- 
tractions. 

The reaction of the muscles in De B ia entirely diiEerent 
** from that of the nerrea 

The muscle reacts almost exactly like the nerre to the 
&radii! current ; a progressive diminution of irritability en- 
Hues, and terminates in complete extinction during the cootse 
of the second week. As in the nerves, this extinction of fora- 
dic excitability continues for a longer or shorter period and 
• then slowly returns to the normal, though somewhat later 
than in the nerves. 

The reaction to the galvanic current is entirely difierent. 
During the first week there is a moderate diminution of gal- 
vanic irritability, bnt during the course and toward the end 
of the second week an increase occurs which may reach a con- 
siderable intensity in the next few weeks, and is combined 
with qualitative changes in the formula of contraction as well 
as its manner. 

The increase of galvanic irritability becomes erident very 
Fio. M. rapidly ; finally, distinct reaction on closure and opening may 

be obtained with eight, six, four, even two elements with a strength of cur- 
rent which scarcely influences the needle of the galvanometer. With this 
increase of irritability a progressive change in the mode of contraction 
also begins ; instead of the normal, short, lightning-like contraction, a 
slow, long-drawn contraction occurs, which passes into continuous teta- 
nus, lasting during the entire duration of the current with relatively feeble 
currents. I regard the slowness of contraction as especially characteristic 
of the De B, and it is present under all circumstances. 

Not less striking than this change in the mode of contraction is the 
coexisting qualitative change in the law of contraction of the muscle. 
This is chiefly caused by the more marked increase of An 01 C ; this 
soon becomes as great as Ca CI C (An CI C = Ca CI C), and in most cases 
becomes considerably greater (An CI C >Ca CI 0) ; next to tbe slowness 
of contraction this is a very important characteristic of the De R. 

This condition is mode evident by the adjoining curves, which show 
only closure contractions. 



SLBCTKIOAL EXAUINATIOH AND ELEOTRO-DI A GNOSIS. 



77 



What is true of An CI also holds good with regard to Ga C ; iTi'i^ 
increases with greater relative rapidity than An O G, and soon equals it, 
though we rarely find Ca O C >Ani) C. However, I have repeatedly 
observed the latter condition. 

IhisoonditioD — increase and qoalitetive change of galvanio irritehihty 
— continues unchanged for a variable period (three to eight weeks). 

A gradual diminution of the galvanic irritability then occurs, while the 
qualitative changes, especially the alowneas of the contractions, continue 
uninterrupted ; greater atrengtha of currents are gradually required to 



no. n.— Onnai of danra onntTUtlDni ti 
» or tbe psniHiil In tba lo : Cb = Ci ~" 



ronto uUilor n^koiTauS^ 



I In tlw dliMlm- 
jlrl. SB eIniMDti : 
DeB. Com Id 



produce the slow contractions. In inrarable cases the dinunution of ir- 
ritability increases more and more ; finally Ca O C disappears entirely 
and a feeble An CI C remains as the last trace of vitality in the muscular 
fibres. Years may elapse before the galvanic irritability of tfae degen- 
erated muscle has entirely disappeared. 

In curable oases, however, the normal conditions gradually return in 
the muscles, and with more or less rapidity according as the regeneration 
occurs sooner or later. But you should never expect that tiie normal con- 
dition will be restOTed forthwith in the muscles, with the return of conduc- 
tion and irritabili^ in the nerves ; the changes in the muscle require some 
time for their retrogression, and it may therefore happen that qualitatively 
normal contractions are obtained for some time tjurough the nerves, 
although the qualitatively abnormal contractions of the De R are still 
visible upon direct irritation of the muscles. The normal reaction returns 



78 BLEOTBO-THEBAPBUnCS. 

very gradnallj ; as a rule, howeyer, the irritability remains below the nor- 
mal for a considerable period after the restoration of mobility. 

Neumann has discovered that the striking difference in the faradie 
and galvanic excitability of the muscles is due to the physical difference 
between the two currents. He ascertained that in such pathological cases, 
currents of a certain duration are alone capable of stimulating the changed 
muscles ; as the faradie currents are of mere momentary duration, they 
remain without effect upon the diseased muscles. If, by any means, the 
galvanic current is made of very short duration, it also remains entirely 
ineffective. But why the degenerated muscles lose the capacity of re- 
action to currents of very short duration remains to be discovered ; it ia 
probably due, in great part, to the chemical and molecular changes in the 
•contractile substance. 

The increased mechanical irritability of the muscles also stands in 
close relation to these changes. It is observed more or less distinctly in 
all cases of this kind and is characterized by the occurrence of a Tery 
distinct but slow contraction upon all kinds of mechanical irritants (best 
upon slight, sudden tapping with a percussion hammer or the finger, upon 
simple pressure, or even rapid removal of a compressing body). This 
symptom usually appears somewhat later and disappears earlier than the 
increase of galvanic irritability, but is often observed for weeks and months. 



LECTURE IX. 

S. Degeneration Beaotion (continuedj-^lim Relation to DegeneraUve Atrophy of the 
Motor l^erres and the MnscleB. Their Description - Comparison of their Ooorae 
with that of the De R — Complete and Partial Degeneration Reaction— Occor- 
renoe of the De R— Diagnostic Conolnsions therefrom — Its I'rognostio Signifl- 
oanoe — Spedai and Critical Remarks. 

It has been establidied beyond a doubt that the phenomena of the 
De B possess intimate relations with certain histological changes in the 
nerves and muscles. 

They are the phenomena of d^eneratiye atrophy of the motor nerves 
and muscles, of which the changes occurring after experimental section or 
compression of the nerves may be regarded as a type. 

The first result of such a traumatic lesion is the degeneration of the 
peripheral portion of the nerve. Within a few (two to four) days the me- 
dullary sheath coagulates and breaks up into dumps, drops, granules, a pro- 
cess which spreads quite rapidly and leads to the formation of masses of 
granules and granular corpuscles. This is associated with softening, de- 
generation, and destruction of the axis cylinder, together with marked 
proliferation of the nuclei in the sheath of Schwann. Gradually a large 
part of the products of degeneration is absorbed and the sheath of 
Schwann merely contains a homogeneous protoplasmic masa This pro- 
cess spreads very rapidly from the site of the lesion toward the periphery 
into the finest ramifications of the nerves. 

These appearances are also associated with changes in the neurilemma ; 
apart from the circumscribed traumatic neuritis at the site of lesion, an 
increase of the nuclei in the sheath of Schwann occurs in the entire periph- 
eral portion of the nerve, together with a considerable accumulation of 
cellular elements in the endoneurium and perineurium ; these become 
transformed into spindle cells and connective tissue, which increases to a 
marked extent, forces itself in broad bands between the individual bun- 
dles of nerve-fibres and into the latter themselves, leading finally to cir- 
rhosis of the nerves. How this hyperplasia of the connective tissue 
occurs is a question ; whether from the irritation produced by the pro- 
ducts of degeneration of the nerves or from paralysis of vasomotor and 
trophic fibres is still undecided. 

After a shorter or longer period, according to the form and severity of 



80 ELEOTBO-THEBAPEUnOS. 

the lesion, more or less complete regeneration of the n^e oocors. The 
unsettled question as to the manner in which this is effected may be left 
to the histologists. To us as electro-therapeutists it is sufficient to know^ 
that it does occur. 

Parallel with the changes in the nerves are analogous histological 
changes in the muscles supplied by them. The first phenomenon notice- 
able is a progressive diminution in the size of the muscular fibres, which 
becomes distinct during the second week, is very considerable after the 
lapse of a few weeks, and, in incurable cases, leads to complete disappear- 
ance of the fibres. The transverse striation becomes somewhat indistinct, 
but fatiy or granular degeneration of the fibres is observed only exception- 
ally. A considerable increase in the number of the muscle nuclei, which 
are accumulated in masses and chains, occurs at the same time ; finally a 
chemical chaDge in the muscular substance develops and is manifested by 
the greater tendency of these muscles to the development of so-called 
waxy degeneration. 

Cellular infiltration and connective tissue proliferation in the intersti- 
tial connective tissue of the muscles also occur, and the terminal result is 
an evident cirrhosis of the muscle, whose atrophic and small fibres appear 
surrounded, after the lapse of a few weeks, by large tough bands of fibrous 
tissue. In incurable cases the entire muscle is transformed into connec- 
tive tissue, which may afterward become the seat of a deposit of fat 

As soon as the regeneration of the nerves occurs, the muscle is slowly 
restored to its normal condition, though this requires a long time. Ex- 
perimental and clinical investigations have proven that these degenerative 
changes are the main cause of the De R 

The degeneration of the peripheral portion of the nerve corresponds 
exactly in point of time to the diminution and extinction of its &iradic 
and galvanic excitability, and is imdoubtedly the cause thereof. With the 
regeneration of the nerve begins the return of the excitability of its periph- 
eral portion. But the electrical irritability reappears somewhat later than 
the conductivity of the nerve-fibres for voluntary impulses or for electrical 
irritation applied to the central portion. This seems to depend upon 
the stage of development of the regenerated fibres ; they do not appear to 
become excitable until they are provided with a medullary sheath of a 
certain vddth, while they are capable of conduction at an earlier stage. 
With the increasing development of yoimg fibres the irritability increases 
but it remains below the normal for some time, partly on account of the 
insufficient development of nerve-fibres and the cirrhosis of the nerves, to 
a stiU greater extent on account of the atrophy and cirrhosis of the mus- 
cles, which do not respond with normal vigor to stimulation proceeding 
from the nerves. 

The degeneration of the intramuscular nerves is the cause of the de- 
pression of their faradic and galvanic excitability during the first week, as 



ELBOTKIOAL BXAMINATIOK AND BLEOTRO-DU GNOSIS. 81 

no dumgea ara noticeable at thia time in the muscular fibres themselTes. 
The chemico-biHtological alterations of the transTerael; atriated aub- 
■tanoe are ondoubtedly the cauae of their inexcitabilit; to the short faiadio 

1. PmJjtia with lalmUToIj aBilj latnin at motion. 



11 



a. PanljiU wtth late Mtnrn of motion. 

nscDantlan Atnpb j of tb* Olntu^ 



L 1 1. a.IlLlt.M.S. ID. «. M. 4h W. H.W<^ 



>. Inonnble panlTdi. Hotl<ni loat pennuientlj. 



J fO«aT. 



DO of aoiplHe Da H vtth nauil to dmIob, ud Uw tuwlio uid g^iutla 
IciUBbtUtjiirtlMncrTaiiidDiiiKaa 

oorrent on the one hand, and the great increase and qnalitatiTe change of 
galronio irritability on the other hand. The further course of these de- 
generative changes, the increasing atrophy of the muscular fibres, cause 
the Uier depreaaion of galvanic irritability. The compensation of these 



82 BLECTRO-THERAPEUnOS. 

<shang68 and the retam of the previous volume of the muscles give rise to 
the restoration of normal irritability. 

With a view to the more ready comprehension of the facts I append 
three plates of De K and its relations to degenerative atrophy. In all 
three the first heavy ordinate indicates the occurrence of the lesion, the 
«udden cessation of mobility (^°°^), its beginning return is indicated by 
an asterisk (*) ; in the first plate you find an early, in the second a late, 
in the third no return of mobility. The figures above the ordinates indi^ 
cate the number of weeks which have elapsed since the occurrence of the 
lesion. The v^avy shape of the line, showing the galvanic irritability of 
the muscles, indicates its qualitative alteration. The short remarks above 
the plates point out approximately the stage of the histological changes io 
the nerve and muscle. 

But it should not be expected that a similar regularity in the course 
of the changes will be observed in all pathological cases, as it is in an ex- 
periment or in simple traumatic lesions of the nervea There are numer- 
ous deviations from complete '' De B," which may be occasioned by the 
form of the lesion, various, disturbances of the trophic influences, tempo- 
rary improvement, constantly recurring fresh disturbances, etc. Even 
the period at which the regeneration of the nerve begins may produce 
great differences in the general symptomatology of the De R If the re- 
generation occurs early, the nerve may be irritable to the faradic and gal< 
^ vanic currents, while the changes in the muscle are still at their height 
It may therefore happen that the muscle reacts in a normal manner to the 
nerves, but direct irritation still produces De R If the regeneration oc- 
curs very late the muscular changes may have passed into the later stages, 
vrith greatly diminished galvanic irritability when the electrical irrita- 
bility of the nerves begins slowly to reappear. 

But there is an entire series of cases in which the course does not cor- 
respond entirely to the above scheme, but only a part of the changes 
develops typically, while the remainder are not developed at all, or only in 
a rudimentary manner. In these cases the irritability of the nerves does 
not disappear, but sinks to a certain, often insignificant, degree, although 
the changes in the galvanic irritability of the muscles are developed in a 
typical manner. I first observed this condition in six cases of rheumatic 
facial paralysis, and have included this category under the term "partial 
De R" 

This can be readily described, and is depicted on the accompanying 
plate. 

Merely a slight depression of faradic and galvanic irritability occurs in 
the nerves ; this is often very insignificant but always distinctly demon- 
strable. It is often manifested more by the diminution of the tnnTimnTn 
contraction than by the later occurrence of the minimum contraction. A 
corresponding diminution of faradic irritability also appears in the mus- 



BLKOTKICAL EXAMINATION ASD ELE0TEO-DIAGNOS18. 88 

de, wbile the galvanic irritability preeeiits the same changes as in com* 
plete De R But experience teaches that in all these cases of partial De 
B, the disease is comparatively mild and disappears with relative rapidity. 

In these cases it is probable that the nerve is not degenerated, or veiy 
slightly, while the muscle presenbi the same histological lesions to which 
we previously attributed the changes in their electrical irritability. 

Experience teaches that all possible gradations may occur between 
normal reaction and partial De B, and between the latter and complete 
De R, and you may not infrequently observe, in the same individual, that 
partial and complete De B are present in different parts of the muscles. 

Occurrence. — You will have foreseen that it is undoubtedly present in 
all forma of disease which are analogous to the experimental division 



Fia. M.— SebmtMlo npiwmtiitlaii of putl^ Dg R. Tbc tusllg ud g^nnls liilablU^ ot tte na^n 
ud tb* tandlo lirlubUlt; of tha miuFl* u* 'Umlnlmbtd to ■ >U«ht axtml^ llutcs pcmr nttinuitaa 
«h1j pcvloil I oom^vta ind ntpld nooTflfy. DegBDwUm al tha narv* pnteUf mlaanL 

or compresfiion of motor nerves, viz. : in so-called trsnmatio paralyseai, 
which are produced by injury, section, rupture, or bruising of the nerve. 
To this category' also belong the numerous compression or pressun 
paralyseB, if the lesion of the nerve reaches a sufficient grade to destroy 
the trophic influenoes. Tou will learn hereafter that in mild forms of 
oompreasion paralysis, motor conduction may be alone disturbecl, while 
llie completely intact electrical irritability allows us to oonolude that all 
trophic disturbances of importance are absent Among tliese compression 
paralyses I not alone indnde those due to external mechanical pressure 
(sleeping on the arm, tight surgical bandages, tourniquets, difficult labor, 
poor crutches, etc.), but alao to internal pathological processes (tumors, 
aneuriionB, extravaaationa of blood, retraction of doatrices, formation of 
callus, joint dumges, etc.). 

Thisalso indudes so-oalled neuritic paralyses, especially those in which 
there is at first interatitial neuritis and mechanical pressure upon Uie motmr 
fibres caused thereby, while in those forms which are described as paren- 



84 SLEGTRO-THBRAPEUnOS. 

ohymatous neuritis, there is a primary degeneration of the nerre-fibre^ 
which gives rise to an abolition of conduction in some part 

De B also occurs in many rheumatic paralyses, eepeciaUy in certain 
forms of rheumatic facial paralysLs. It is probable that, in these cases, 
slight neuritic changes are associated with compression of the nerres (es* 
pecially during their course through narrow, bony canals). 

De B is also found in spinal diseases, so far as these a£Eeot the gray 
anterior columns of the spinal cord ; therefore in the various forms of an- 
terior poliomyelitis, in its acute as well as its subacute and chronic forms ; 
also in the disseminated chronic, progressive form (typical progressive 
muscular atrophy), and no less in chronic progressive bulbar paralysis, 
aaturally also in so-called amyotrophic lateral sclerosis. In all these 
chronic forms, however, the De B usually appears in a part of the muscles 
alone and in great part as partial De R The latter may also be observed 
in all the forms of disease previously mentioned (with the exception of 
severe traumatic paralyses). 

You will not be astonished to hear that De B is oonanionaHy observed 
Vi hemorrhages into the q>inal cord (hsBmatomyelia), if the gray anterior 
eolumns of the cervical or lumbar enlargements are imjdicaited, also in 
various forms of acute and chronic myelitis, in tumors of the spinal cord 
under similar circumstances ; it is also a constant symptom in lead paraly- 
sis, with regard to which we are in doubt whether it owes its origin to a 
lesion of the anterior gray coltunns or of the peripheral motor fibres. It 
may also be mentioned tiiat the De B in lead paralysis is occasionally 
observed in muscles which are not paralysed, and in whi<di txvqohic disturb- 
ances are, therefore, alone present. 

De B is also found occasionally in diphtheritio paralyses whidi, m 
part at least, are attributed to neiuitic and degenerative changes in the 
aerve-trunks and the motor-roots of the nerves. It may also be observed 
in paralysis after acute diseases (neuritis, hemorrhage, poliomyeKtis, etc.), 
also in paralysis from syphilis, etc. 

De B has never been observed in paralysis of cerebral CMrigin {from 
lesion of the conducting paths above the gray nudei of tile medulla ob- 
longata, or from lesion of the cerebral cortex) ; it never occurs in paraly- 
sis from disease of the white columns of the cord (with the exeeption of 
the anterior root-bundles), or in hysterical paralysis. 

I also lay stress upon the fiact that De B has never been found in tuif 
doubted local and primaiy aflbctions of the muscles ; not in myositis snd 
espedaUy not in the so frequent atrophy and paresis of the musdes aftsr 
joint diseases ; it is also entirely absent in all atrophies from disuse. 

The following conclusion may be drawn vrith regard to the presence of 
De B^ viz., that it presupposes the existence of considerable anatomical 
changes (degenerative atrophy) in the nerves and musdes (perhaps in tike 
latter ahme). 



SLEQTBICAL SZAKUTATION AKD ELBOTBO-DIAGNOSIS. 85 

We may also conclude that the paralysiB or atrophy which is present 
has a neurotic origin, and that some serious disorder must be situated 
either in the jMripheral motor conductors^ or in the trophic centres of the 
central organ, i.e., in certain portions of the anterior gray substance of the 
spinal cord or the medulla oblongata. 

With regard to their nutritive conditions the motor nerves and mus* 
eles are under the influence of certain nervous apparatus (trophic centres), 
by whose continuous action they are retained in a normal histological and 
functional condition. We may entertain the suspicion that the liu^e mul- 
tipolar ganglion cells^ or at least a part of them, possess these trophic 
fiinction& 

Every separation of the peripheral nerves and muscles from this cea« 
tnd apparatus disturbs their trophic actions, and the j^ripheral parts will 
undergo progressive degeneration until the connection with the centres is 
again restored. It is immaterial with T^egard to the effect whether the 
separation is due to interference with conduction or interruption of con- 
tinuity in the jMripheral paths, or to destruction or abolition of function 
of the centres : in both events degeneratiye atrophy is inevitable. 

How these trophic influences produce their effsct is merely a matter of 
conjecture. But all facts hitherto known agree in this, viz. : that true 
degeneratiTe atrophy and De B occur in neurotic disorders alone and 
that these possess a definite situation ; De B does not occur in undoubted 
primary affections of the muscles. 

But there are cases of simple atrophy of the muscles, vrithout degen- 
eratiye changes and vrithout De B, which may attain very high grades ; 
they occur not infrequently in the last stages of severe spinal paraplegia^ 
sometimes in consequence of severe cerebral paralysis ; a somewhat simi- 
lar condition is found in progressive unilateral atrophy of the &oe. From 
our previous experience we may assume that, in such cases, the gray an- 
terior columns must be intact. This view has received corroboration from 
Striimpell's recently published case of spinal disease, in which extensive 
atrophy was present without any degenerative disturbance, without De B 
— but also without degeneration of the anterior gray column& But we 
are still ignorant as to the real cause of this form of atrophy, whether it is 
due to simple inaction or to some other form or degree of trophic dis- 
turbance. Perhaps a portion of the muscular atrophies, which are so fre- 
quent in joint affections, belong to this group. 

To return, after this digression, to the De B, its occurrence only 
teaches us, with reference to the diagnosis of any affection which may be 
present, that certain histological changes — degenerative atrophy — are pres- 
ent in the nerves and muscles, whence follows immediately a conclusion 
with regard to the severity of the lesion and the degree of disturbance of 
conduction. 

With regard to the site of the lesion the De B merely shows with 



86 ELEOTBO-THSRAPEUnOS. 

certainty that we have to deal with a neurotic affection, and that the 
lesion must be situated either in the peripheral nerves, the motor roots, 
or the gray masses of origin. A true cerebral affection is positively ex- 
cluded by the presence of De R 

With reference to the diagnosis of the kind of lesion, little can be 
determined, from the presence of De B^ with regard to the more imme« 
diate cause of the paralysis. 

Very important and practically valuable conclusions may be drawn in 
many cases with regard to prognosis. 

Under otherwise similar circumstances, i,e., in one and the same form 
and cause of disease, the lesion is so much more serious, the duration of 
the disease the longer, the chance of complete restitution slighter — the 
more developed and complete the De B is and the more advanced the 
stage in which it is found. Partial De R is therefore more favorable 
than the complete, the later stages more unfavorable than the earlier. A 
prognosis may thus be made in the individual forms of disease. 

The most striking example of this is afforded by ordinary rheumatic 
facial paralysis, three forms of which are distinguished according to the 
duration and severity of the disease and are recognized by the results of 
the electrical examination. If the electrical irritability is entirely normal 
(mild form), the prognosis is very favorable and the disease will last two to 
three weeks ; if partial De B is present (middle form), the disease will con- 
tinue about one or two months ; but if complete De B is present (severe 
form), the prognosis is relatively unfavorable and the paralysis will last 
from three to nine months or longer. Similar statements with regard to 
prognosis will also hold good of compression-paralysis of the radial nerve, 
and of one form of spinal disease, viz., chronic anterior poliomyelitis. 

It must not be forgotten, however, that these prognostic rules do not 
obtain for all possible paralyses but for those alone which possess a certain 
etiology and similar localization. It is therefore only true of rheumatic 
facial paralyses inter se, or of compression paralyses of the radial nerve 
inter se / but it is not permissible to compare a cerebral facial paralysis 
with one due to caries of the petrous portion of the temporal bone, or 
the latter with a rheumatic paralysis, or to compare the conditions of a 
compression paralysis of the radial nerve with one produced by the forma- 
tion of callus, or with progressive musctdar atrophy in this region. 

The description of De B here given does not by any means pretend to 
be exhaustive in all directions and details ; it furnishes merely the general 
typical picture, its regular appearance in simple and uncompUcated cases. 
But I will not fail to add a few explanatory and special remarks. 

I}- lies in the nature of the case that all kinds of variation from the 
typical condition occur ; pathology does not deal with simple and smooth 
experiments, but with varying, complicated, fluctuating, morbid processes. 
Th^ir more rapid or slow development, the occurrence of improvement 



ELECTRICAL EXAMINATION AND SLE0TBO-DIAGNO8IS. 87 

and relapse, so that processes of degeneration and regeneration are 
mingled witii one another, instead of developing in a regular series ; cir- 
cumscribed or manifc^d disseminated lesions, which affect only individual 
parts of the nerves and muscles in varying combination ; repeated occur- 
rence of degenerative atrophy in the same neuro-muscular tracts, as, for 
example, in recurring lead palsy ; combination of various disturbances, 
vtrhich may lead at the same time to different kinds of change of electrical 
irritability — these are the chief factors which may disturb the regular 
course of the De R As a matter of course, they produce an extraordinary 
variety and complication of conditions, which we must expect in patho- 
logical cases, and whose disentanglement and explanation can only be ef- 
fected when we constantly keep in mind the possibilities just mentioned. 

Above all, however, a very careful and skilful examination is neces- 
sary ; by a large experience tdone can the De R be recognized under less 
favorable circumstaiices and the characteristic peculiarities determined 
when they are very slightly marked. Especially in the later stages it is 
always very useful to introduce the greatest possible quantities of current 
into the muscles, in order to compensate somewhat for the advanced 
diminution of irritability : therefore large electrodes should be employed, 
the skin well moistened, the strength of the current increased by changes 
of polarity, perhaps both electrodes placed upon the muscle, and disturb- 
ing contractions of other muscles excluded as much as possible. The 
latter precaution is especially serviceable in examination of the small mus- 
cles of the hand, the ball of the thumb and the interossei, and is effected 
readily by applying the indifferent electrode either to the dorsal surface 
of the wnst-joint or the palm of the hand. 

By means of these and similarly modified applications (made in 
accordance with Ohm's laws), it is usilally possible to distinguish the rel- 
atively feeble and slow contractions of De R from the more vigorous con- 
tractions of the adjacent muscles. This can be rendered still easier by 
excluding the movements of the healthy muscles by means of suitable fix- 
ation, fi the irritability is very much depressed during the latest stages 
and when the muscles are uninfluenced, it may happen that the excita- 
bility does not make its appearance distinctly until after repeated exami- 
nations. Very useful and important in many cases in the demonstration of 
beginning or slight degeneration, is the recognition of a form of " double 
contraction " which I have often observed and demonstrated : upon closure 
a short, Hghtning-like contraction of the adjacent healthy muscles is ob- 
served at the beginning and is followed immediately by the slow, charac- 
teristic contraction of De R This may be noticed very distinctly in lead 
palsy, in which, upon stimulation of the extensors of the forearm, a short, 
lightning-like flexion of the hand and fingers occurs and is immediately 
followed by slow, less marked extension of these parts. It is very instruc- 
tive, also, when, in beginning De R, Ca CI produces a vigorous, lightning- 
like contraction, An CI a slow, long-drawn contraction in one and the same 
muscle ; this may be observed with special distinctness in bulky muscles 
(triceps or biceps brachii, vastus intemus, etc.). 

In certain cases of De R the stage of increased excitability appears to 
be very short, perhaps entirely absent, and the qualitative changes of 
excitability then develop alone. I lay much more stress upon these 
latter changes than upon the increase of excitability ; the De R will always 
be recognized most certainly by the slow, insufi&cient contractions and the 
predominance of An 01 action. 



88 EUSCTBO-THEBAPSUnCS. 

Frequentlj no distinct changes can be demonstrated in old cases; 
there may be merely a simple diminution of excitability, including the 
galvanic excitability, and it may be doubtful whether De B has been pres- 
ent or not In this event there may be numerous combinations with the 
simple diminution of electrical irritability due to spinal diseasea 

It is a very interesting and theoretically important &ct that well-deTel- 
oped De B is noticed occasionally in muscles which are not at all paralyzed 
or present merely a moderate and insignificant diminution of mobility. I 
noticed this first in a case of lead palsy ; the deltoid presented no appreci- 
able disturbance of motion, but marked typical changes of galvanic excit- 
ability with slight diminution of faradic excitability (the nerve-trunk vras 
not examined). East has recently described a case under my observatioii 
in which the thenar musdes, although retaining normal power, presented 
complete De B, i.e., the nerve itself was inexcitable to taradic and galvanic 
currents. • 

. A different reaction of the nerve to the feradiq^and galvanic currently 
analogous to the De B in the musdes, has been observed in very excep* 
tional instances. 

It is a more noteworthy fact that> during a certain stage of De B, tiia 
degenerated musde reacts with an exquisitely slow contraction to bmdie 
stimulation and to stimulation through the nerve. In this event the 
muscular fibres are evidently so degenerated that they are no longer cap- 
able of contracting quickly as they usually do, for example, in cases of 
partial De B^ when stimulated through the nerve. This peculiar reaction 
appears to occur only when the nerves are regenerated, or at least only in 
the later stages of the entire process^ when it has run a very long course. 



LEOTTJEE X. 

4 Buer QnantiMife and QoAlitafciTe Ohaoget of Bleotrioal InitaUlitj: a. Inareate 
of Seoondarjr Irritability (CooToliible Beaotion) — b. Diminution of Secondary 
Irritability (Ezhauation Beaotion) — o. Qoalitative Changes in the Law of Con- 
traoUon of Motor Nerrea — d. Different Beaotion of the Nerves to the Faradio 
and QalTanio Currents —^ Latent Period of Irritation in Faradio Stimnlation of 
the Mn ao i aa / Diplegio Oontraotions~B. Electro-diagnosis of the Sensory 
Nerres — Anoinaliea of Farado-ontaneons and Farado-^ln^calar Sensibility. 

4. RaEKB QuAMTITATiyS AND QuALTTATIVB ChaMGES OF ElBOTBIOAL IbBTTA- 

BnJTT. 

Lf ihifl section I will give a short desoription of yarious rare forms of 
dectrical reaction which have been observed occasionally but whidi are 
at the present time devoid of practical significance. 

a. Benedict has described as convulsible reaction a quantitative change 
of irritability in which, after the current has been allowed to act for a 
short time, tiie contractions produced are much more vigorous than 
normal, and may even be intensified into convulsiTe contractiona This is 
probably the same as Brenner's ** increase of secondary irritability. Under 
the term " secondary irritability '' he refers to the degree of irritability, 
expressed in numbers, which is produced by the action of the current 
itself upon the nerves. H for example, the nerve in the beginning shows 
the first Ca CI C with sixteen elements, and after the current has passed 
for some time with twelve elements, *' sixteen elements " indicates the 
primary, ** twelve elements " the secondary irritability of the nerve. The 
farther these figures become removed from one another, the less, there- 
fore, the number of elements which prove e£fective at a later period, the 
greater the secondary irritability, and vice versa. Unfortunately, the part 
played in this secondary irritability by changes in the resistance to con- 
duction of the current itself has not been accurately determined, and to 
the latter must probably be attributed the lion's share of this phenomenon. 
But there is no doubt that cases occasionally occur which indicate a real 
change of irritability in this sense, as in certain psychoses, tumors of the 
brain, certain spasmodic diseases, chorea^ tetany, etc.; but its occurrence 
has no appreciable practical significance. 

b. The antithesis of the previous anomaly is the diminution of sec- 
ondary irritabUUy, the reaction of exhaustion. While healthy nenres and 




90 ELEOTBO-THBRAPEUnOS. 

muscles show no appreciable exhaustion and maybe repeatedly stimulaied 
effectively by the same irritant, it may happen under pathological condi- 
tions that the primarily effective strength of current afterward becomes 
inefficient. For example, the minimum contraction at first occurred at 
180 nmi. withdrawal of the cylinder ; after some time, not until 160 mm. ; 
and finally at 140 mm. Or the first Ca CI C occurs writh sixteen elements, 
but, after repeated closure of the current, eighteen or twenty elements 
are required to produce contraction. 

This phenomenon has been observed in paralysis from disease of the 
cerebral hemispheres, in progressive muscular atrophy and in apoplectic 
hemiplegia ; it has also been found in a case of true muscular hypertrophy, 
and in another case of probable chronic anterior poliomyelitis, temporarily 
during the gradual depression of faradic irritability of the muscles in the 

transition to De R 

c. QucditcUive change in the law of contraction of the nerves. Qualitative 

changes in the law of contraction are as rare in the nerves as they are 
common in the musclea Brenner, despite his extensive experience, has 
never observed any of these changes. 

In two cases I observed, in the ulnar nerve, the occurrence of An CI C 
before Ca CI C, the contraction being of a purely nervous character (short, 
lightning-like). Both cases were chronic affections of the spinal cord, one 
being locomotor ataxia, the other a complicated disease (spastic paralysis 
of the legs, paresis with exaggerated reflexes in the arms, sensory disturb- 
ances, indication of ataxia in left arm alone, etc.). In this case An CI C 
occurred earlier and more vigorously in the left ulnar nerve with feeble 
currents, while the normal condition was presented when stronger currents 
were employed. More careful examination showed : 

With 10 elements An a C Ca CI 
12 « AnaC> CaaC 
14 " AnaO Ca'aC 
16 " AnClC'=Ca'C10, 
18 " CaClC"> An CI C, An 00 
20 " CaClC"> An CI C, An 00, Ca 00 

Peifina has repeatedly observed a similar predominance of the An CIC 
in cerebral tumora 

Eumpf has found that the An 00 occurs earliest and most readily if 
the nerves in question are separated from the central organ. He has also 
observed this in the human subject : 

1. Crutch paralysis of the radial nerve, 15th day : 

Healthy side. Diteased side. 

Ca CI with 11"" deflection of needle ; 12^ deflection of needle. 

An 010 " 29^ " " 30° " « 

An " 36° " " 25® " " 

This shows increased irritability of An O. 



ELEOTBIOAL EXAMINATION AND ELEOTBO-DIAGNOSIS. 91 
2. Compression paralysis of the radial nerve, 8th day : 

Healthy side. Dioeaced nde. 

Ca a C with 21^ N D. 33^ N D 

Ca D C> " 38^ " 37^ " 

AnClC " 36° " 35° " 

AnOC " 32° " 23° " 

In this case, accordingly, diminution of irritability to Ga CI and in- 
crease to An O. 

d. Different reaction of the nerves to the faradic and galvanic currents. 
Soon after the discovery of the De B the difference in the reaction of the 
muscle to the faradic and galvanic currents was also supposed by the ma- 
jority of observers to hold good with regard to the motor nerves. I showed 
that this opinion is incorrect and that in Be B the nerve reacted in exactly 
the same manner to the faradic and galvanic currents. It appeared indeed 
as if this were always the case, at least no other result was obtained in the 
innumerable observations of De B in the human subject. 

But there are a few facts which prove that this change of irritability in 
the nerves really occurs. Bernhardt has recently described a case of trau- 
matic ulnar paralysis in which this nerve presented distinct diminution of 
faradic irritability, and a not inconsiderable increase of galvanic excita- 
bility. But this case belongs imdoubtedly to De B^ despite the incompre- 
hensible repeated assurance of the author '' that no De B was present ; " 
according to the clinical history, the muscles suppHed by the uhiar nerve 
presented increased galvanic excitability, predominance of An CI C, and a 
slow mode of contraction, with markedly diminished or entirely extin- 
guished faradic irritability. 

c. Latent period of irritation in faradic sHmiUation of the muscles. By 
means of an apparatus devised by Marey, M. Mendelssohn has measured 
the period of latent irritation of the muscles in the himian subject ; he 
employed only the faradic current as the irritant, and found that this 
period presented a variable duration (0.006 to 0.008 second on the aver- 
age), dependent on the intensity of the current on the one hand, and on 
the irritability and contractility of the muscles on the other hand. 

Under pathological conditions, numerous variations occurred in the 
duration of this period of latency ; it stands in an inverse relation to the 
irritability and contractility of the muscles. Its duration diminishes 
constantly in contractured muscles, and increases with the existence and 
intensity of trophic changes in the musclea Thus, Mendelssohn found a 
diminution of the period of latency (to 0.003 second) in hemiplegias with 
contracture of the musdes, in spastic spinal paralysis, chorea, etc. ; and a 
prolongation of this period (to 0.02 to 0.04 second) in hemiplegia compli- 
cated with atrophy, in progressive muscular atrophy, in amyotrophic lateral 
sclerosis, in ataxia during the stage of paralysis and atrophy, and also in 
hysteria (0.009 to 0.015 second). 



92 XLBOTBO-THEBAPSUnOS. 

It would be interesimg to investigate somewhat more olosely the lela- 
tions of the period of latency in degeneration reaction. 

/. Diplegic contractions. Under this term R Bemak first called attention 
to remarkable phenomena of contraction which occur in rare cases if the 
electrodes of the galvanic current are arranged in a certain manner. If 
the button-shaped anode is placed in one mastoid fossa, or upon the adja- 
cent part of the neck, and a Inroad plate-diaped cathode is pat between 
the scapuke or even somewhat lower on the other side of the vertebral 
column, peculiar, more or less vigorous movements will occur in the arm 
on the side opposite the anode, even if the electrodes are kept immovable. 
The contractions are said to remain absent if the position of the electrodes 
is reversed, also if the Ca is brought into the region of the neck. 

Bemak looked upon these contractions as reflex and regarded the 
superior cervical ganglion as their chief point of departure, later the sim- 
ultaneous irritation of two sympathetic ganglia. The electrodes must 
therefore be situated far apart The occurrence of diplegic contractions 
may be facilitated and strengthened by the administration of strychnine. 
Bemak observed them especially in progressive muscular atrophy and 
arthritis nodosa and attributes great curative properties in these diseases 
to galvanic treatment by means of this diplegic arrangement of the elec> 
trodes. 

These phenomena have been rarely observed by later writers. Driseen 
found diplegic contractions in a vasomotor neurosis and in paresis of the 
nerves of the arm ; Moriiz Meyer in arsenical paralysis, Fieber in lead 
paralysis, apoplectic paralysis, etc, Eulenburg in lead paralysis ; Eisenlohr 
found them slightly developed in bulbar paralysis (but with reversed poei^ 
tion of the poles). I have observed feeble diplegic contractions in a case 
of progressive muscular atrophy ; in a case of atrophic paralysis of the 
arms, with sensory and trophic disturbances of the skin (neuritis ? spinal 
disease ?), they did not occur distinctly until the patient had taken strych- 
nine for some time ; in a third case of atrophy of the muscles of the hand 
and forearm (the interpretation of which was difficult) rhythmical con- 
tractions occurred in various muscles of the fingers and forearm upon 
diplegic stimulation with both directions of the current ; the muscles re- 
mained motionless on direct irritation of the brachial plexus. 

The statements of various observers with regard to the best manner of 
producing these contractions only agree to a slight extent with those of 
Bemak. Fieber could produce the contractions with the faradic current 
Moritz Meyer produced them from other points (pit of stomach, dorsal 
spine), while Eulenburg found that they appeared " upon crossed and 
even unilateral application to any part of the surface of the trunk with a 
stabile or labile current ** You thus see how different the statements are 
with regard to these diplegic contractions. They possess no special im- 
portance from a diagnostic or therapeutic standpoint To this catefifory 



ELBOTBIOAL SXAMINATIOlf AND SLEOTRO-IMAGKOSIS. 



93 



of reflex phenomena belong also the '' galvano-tonio reflex contractions'* 
which were so oarefoUj studied by Bemak, and also the contractions ob- 
tained, upon galvanic stimulation of a leg, in the arms or the non-irritated 
leg (in hemiplegia, ataxia, etc), and which ^re said to be caused by cen- 
tripetal action of the current. It is probable that these phenomena are 
due merely to an unusual degree of reflex irritability ; tiiej possess no 
practical signiflcance. 



ft. THE CHANGES IN THE ELBOTBIOAL IRRITABILITY OF THE SENSORY 

NERVEa 

From a pathological standpoint i^eiy Utile is known with regard to ii» 
electrical reactions of the sensory nenres. We are acquainted only with 
simple increase (hyperesthesia) or diminution (anaesthesia) of electro-cu- 
taneous sensibility, which usually runs parallel, to a greater or less extent^ 
with the disturbances of the remaining qualities of tegumentary sensation 
(especially the sensation of pain). These disturbances may occur in tbe 
most different morbid conditions and are determined by the methods pre- 
fiously described (Lecture VIL, p. 66). Electridty serves merely as a 
test of function and does not determine ihe changes in the irritability of 
the conducting paths, as it does in the case of the motor nerves. 

Thus we can ascertain that the electro-cutaneous sensibility is increased 
or diminished in various peripheral as well as central (eq>ecially spinal) 
diseases, and in what parts this occurs; Especially in unilateral affections 
we can often determine very slight changes by faradic examination better 
than by other methods of testing sensation. As an iUnstration I append a 
case of traumatic lesion of the vertebral column, followed by slight weak- 
ness and anaesthesia of the left leg, the latter qfmptom being readily de- 
tected by the electrical examination. 

A man, aged twenty-four years : 



^tAoA oHoHtMoD, 




Fain. 


Deflwtioii of needle 

with IS elementi, 

160CB 


Cheek 


Bitbt 

280 
200 
180 
144 
180 
196 
106 


Left 

206 
196 
166 
140 
142 
142 
77 


166 
162 
160 
110 
188 
146 
75 


Left 
aide. 

164 
162 
186 
112 
119 
100 
62 


12»-16° 


Neck 


8"»_ 4" 


Forearm 


8°- 8° 


Tip of finflfers 


6°- 4° 


TWgh 


8"*- 2*" 
2»_ 2* 


CJf 


Sole of foot 


4°- 6" 







94 



BLEOTBO-THEBAPEUnOS. 



In locomotor ataxia it has been ascertained that the electro-cutaneoas 
sensibility runs parallel, on the whole, with the sensibility to pain, and that 
if analgesia is present, tactile sensation being unimpaired, the minimuTn 
of faradic sensibility as well as of the faradic sensibility to pain first de- 
velop with much higher strengths of current In many cases the farado- 
cutaneous sensibility appears simply diminished over the entire body and 
the difference in the withdrawal of the cylinder for the minimiini sensa- 
tion and pain is not much greater in many ataxics than in healthy persons. 
But the faradic examination discloses anomalies which may readily escape 
observation by the ordinary examination of sensation. The following case 
will serve as an illustration. 

Locomotor ataxia, man aged thirty-six years (the numbers for both 
sides of the body are grouped together, as they were approximately equal) : 



Pointo of Ircitafcion. 


Minimum in 
mm. 


Pkinin 
nun. 


IMfeotion of 

nMcUa. 
10 demente. 


Cheek 


160 
164 
164 
162 
144 

90 
186 
128 
120 
112 

86 


120 

110 

110 

108 

103 

70 

100 

86 

78 

70 

46 


26"" 


Neck 


20° 


Arm 


12° 


Forearm 


7" 


Pormim of hand ................... 


10" 


Tips of fingers • . . 


8° 


Abdomen 


16° 


Thiirh 


6' 


Calf 


6'' 


Dorsum of foot ..........t-tf^.... 


4** 


Sole of foot 


10** 







A comparison with the normal tables distinctly shows the general dimi* 
nution of farado-cutaneous sensibility. 

In but one case of ataxia did I find an evident farado-cutaneous anal- 
gesia, while the numbers of the minimum sensation were scarcely dimin- 
ished. In this case the numbers of the minimum farado-cutaneous sensa- 
tion varied from 203 mm. (cheek), 170 (arm), 177 (thigh), 150 (sole of 
foot), but absolutely no sensation of pain could be produced in any part of 
the body by the most powerful current This condition appears to be ex- 
ceptional, however, even iniocomotor ataxia. 



LECTUEE XI. 



O. Elaotro-diagnosis of the Nerres of Speoud Senae. 1. Optio Nerve and Retina — 3. 
Aoonstio Kenre and Anditozy Apparatus — a. Simple GalTanio HTperassthesia — h, 
HTpenesthesia with Ohaoge and BoTersal of Normal Formula — 6. QualitatiTe 
Anomalies without HyperaBstheeia — d. Torpor — 8. Nerves of Taste— Eleotrodiag- 
nosis of the Vasomotor Nervea, the STmpatbetic, Pneomofaatrio, Central Ner- 
Tons System, etc. 



C. OHANGBS IN THB BLBOTBIOAL IRBlTABILriT OF THB NBBYBS OF 

SPBOIAL SBNSB. 

1. To my regret I must admit that very little is known with regard to 
the pathological relations of the electrical irritability of the retina and 
optic nerve. 

It has long been known that the galvanic reaction of the visual appara- 
tus diminishes and disappears in amaurosLs, atrophy of the optic nerve, 
and similar lesions, but Neftel first made detailed statements based upon 
Brenner's method of examination : in a case of hemianopsia he found a 
corresponding defect in the galvanic color disk, and this is also said to oc- 
cur in separation of the retina ; he finds that, as a rule, the galvanic reac- 
tion of the eyes is parallel with the acuteness of sight. 

I have made a few investigations in this direction but I must confess 
that they are incomplete in many respect& 

I maJce brief mention of the following personal cases : 

1. Double optic neuritis with secondary atrophy of optic nerves ; am- 
blyopia (fingers visible at 6 and 2 feet). Feeble galvanic sensation of 
Ugbt on both sides : whitish, wil^out any difference between both poles or 
at ojMning and closing the current 

2. Fracture of skulL Left eye completely amaurotic ; right eye, am- 
blyopia and temporal hemianopsia. No galvanic reaction in left eye ; in 
the right eye galvanic sensation of light, confined almost exclusively to 
median (left) half of the field of vision. 

3. Case of locomotor ataxia with complete amaurosis from atrophy of 
the optic nerves ; formerly had distinct galvanic sensation of light ; this is 
now entirely absent, however strong the c\irrent employed. 

4. Tumor cerebri (?). Bilateral complete amaurosis ; at first choked 
disk, later white atrophy of the optic nerves : indifferent electrode placed 
upon the neck ; when tne active electrode is placed upon the right temple, 
upon the right or left closed lid, a sensation of light is product upon the 



96 BLSOTBO-THEBAPSXTnOS. 

right side alone, upon Ca CI and An CI ; if the actiye electrode, howeTer, 
is placed upon the left forehead, then a feeble sensation of light is per- 
ceived upon the left side in addition to that on the right 

5. Amblyopia of right eye from retrobulbar neuritis. Vigorous gal- 
vanic reaction in the left eye ; no sensation of light in the right eye with 
6 and 8 elements ; a few months later, after distinct improvement of vision 
had occurred, the right eye also reacted distinctly, but more feebly than 
the left 

6. BUateral amaurosis as the result of a pistol-shot wound of the left 
temple ; feeble vision on left side, absolute blindness on the right side ; 
smdl lost Distinct sensation of light on right side, with 4 to 6 elements 
and the most direct galvanic stimulation possible. On the left side, feeble 
sensation with 2 elements, strong sensation with 4 elements (oonsiderable 
improvement of vision at a later period). 

I refrain from drawing any conclusions from my observations, but I 
believe that the study of this field would be well repaid and I recommend 
it to the attention of ophthalmologisis. 

2. We are much more fortunate with regard to the electro-pathological 
reactions of the nervous auditory apparatus. It has been found, in a cer- 
tain series of cases, that the results of the electrical examination not alone 
furnish indications for electrical treatment, but also for the special method 
to be adopted. In most cases we have to deal with obstinate ^nnitn^ an- 
num, which can be relieved by no other method but is often cured by the 
galvanic current 

Brenner in his investigations found a number of anomalies in the gal- 
vanic reaction of the acoustic nerve, all of which have been corroborated 
by later observera The most frequent of these is 

0. Simple galvanic hypercesthesia of the acoustic nerves. It is chaxacter- 
ized by more ready irritability of the nerve without any change in the 
normal formula. The readiness with which the nerve reactain such cases 
is often astonishing ; the complete formula of acoustic reaction may be ob- 
tained with a scarcely perceptible current 

Increased reaction to very feeble currents is therefore the first and 
most striking criterion of this galvuuohypersesthesia; it is manifested not 
alone by the fact that Ca CI produces sensations veiy early, but also that 
An O sensations occur with relatively feeble strengths of currents, near to 
Ca CI sensation. 

The sensations of sound are also imusually loud and of very marked 
timbre and character (loud whistling, hissing, ringing of bells, etc.). 

Furthermore, these sensations continue much longer than normal, so 
that very soon the Ca CI ringing continues during the entire duration of 
the closure of the current, although with somewhat diminished intensity, 
and the otherwise momentary An O reaction is converted into a more or 
less prolonged (sometimes 20 to 40 seconds) loud ringing, whioh gradual^ 
subsides. 



ELOiCTBlCAI. EXAMINATION AND ELECTRO-DIAGNOSIS. 97 

Brenner has further shown with regard to this hyperffistheeio, that the 
secondare and tertiary irritability is cODSiderably increased, and that the 
increased irritability ie raanifeated with simple positive and negative 
changes of polarity, as well as iu various other respects. 

Brenner's " parados reaction " must be regarded as au especially high 
grade of hypersesthesia. This is characterized by the fact that when one 
ear alone ia armed and examined — the other elecljxide being placed in the 
hand or on the sternum — the uuarmed ear also reacts, in the same manner 
as if it were armed with the indifferent electrode. This condition appears 
paradox because Brenner has shown that the ac- 
oustic nerve always reacts to the electrode situat- 
ed nearest to it. But it can be readily shown 
that, in the method of application referred to, 
the threads of current entering the skull at the 
one ear must leave it in the neck, whether the 
indifferent electrode is situated in the neck, 
sternum, leg or hand ; this condition is the same, 
however, as if the indifferent electrode occupied 
tiie entire neck. But the unarmed ear is in closer 
proximity to the neck than to the armed ear, and 
consequently It must react to the indifierent elec- 
trode situated in the former locality. Thus this Mmiofth 
phenomenon loses its paradoxical character. It with th> ak -. im khiwh « im tik 
ianotbingmorethan the expression of BO marked " ** '■"'""■'' 
an increase in the galvanic irritability of the acoustic nerve that even the 
feeble currents which reach the unarmed ear are capable of evoking sen- 
sations of sound in the latter. It would be better perhaps to discontinue 
the use of the term "paradox reaction." 

Simple galvanic hyperteathesia of the acoustic nerve is a very common 
phenomenon ; I have very often found it accidentally in individuals who 
were scarcely aware that their auditory apparatus was not normaL It 
occurs with very moderate disturbance of hearing, with but slightly dia- 
tdnguishable changes in the enr (opacity and retraction of the membrana 
tympani, partial atrophy of the latter, etc.) ; very frequently in all pos- 
sible chronic diseases of the ear, old purulent otorrhoea, purulent inflam- 
mations of the middle ear, destruction of the membrane, chronic catarrh 
of the middle ear with difficulty of hearing and tinnitus aurium ; also in 
caries of the petrous portions of the temporal bone, in gunshot and other 
injuries of this bone from fractures of the skull, in rheumatic and trau- 
matic £icial paralysis, etc 

Brenner has also pointed out a strikingly frequent coincidence of this 

(and other) pathological reactions of the auditory nerve with central or 

intracranial disturbances in the organ of sight ; as in parulysis of the 

ocular muscles, mydriasis, paresis of accommodation, etc, following frao- 

7 



98 SLSOTBO-THERAPSUTIOS. 

tores of the slnill or intracranial diseases of various kinda This is fre- 
quently merely an accidental coincidence, but in many cases there is n 
direct connection, the central disease giving rise to both disturbancea 

In fact, galvanic hypersesthesia (and other anomaUes) of the acoustio 
nerve are occasionally observed in central diseases (locomotor ataxia, 
chronic myelitis and encephahtis, cerebro-spinal meningitis, tumors, etc.). 
Onieir intimate connection with the central disease has not yet been as- 
certained. Very interesting also is the repeated demonstration by Jolly 
of galvanic hypersesthesia of the acoustic nerve (with or without qualita- 
tive anomalies of the formula) in auditory hallucinations. 

Brenner has formulated a very attractive explanation for the develop- 
ment of galvanic hypersesthesia in ear diseases. He starts with the well- 
known fact that our nerves of special sense fall into a condition of 
increased irritability if their adequate stimuli are withdrawn for a pro- 
tracted period ; if kept for a long time in the dark, we therefore learn to 
distinguish our surroundings, are dazzled by ordinary daylight, and re- 
cognize electrical images more distinctly in the dark than in the light 
This is also true of the auditory nerves ; but if this condition of deprivation 
of auditory stimuli lasts for a long time, nutritive disturbances occur in 
the nerves, which are manifested by increased and perverse reaction of 
the auditory nerve, and may finally lead to diminution of irritability. 

This explanation will hold good for those cases alone in which the gal- 
vanic hyperdesthesia is combined with disturbances of hearing, with 
diseases of the auditory conducting apparatus ; and these cases undoubt- 
edly form the majority. But there are cases of galvanic hypersesthesia 
(even with a change of the normal formula) in which no trace of auditory 
disturbance can be demonstrated, and some other mode of development 
must be acknowledged for such instances. 

The coincidence of simple hypersesthesia with nervous tinnitus aurium 
is extremely frequent and practically of the greatest importance. I will 
refer to this subject in the section on therapeutics. It may here be men- 
tioned that a part of these subjective noises appear to develop in the 
nerve itself. In many of these cases simple hypersesthesia of the auditory 
nerve is present, and they are characterized especially by the fact that the 
Electrical current has a sedative influence upon the tinnitus aurium. As 
a rule, the subjective noise ceases forthwith and completely at An CI and 
An D, but occurs with its former or increased intensity at An O, while Ca 
01 and Ca D cause a considerable increase of the roaring, and Ca O a tem- 
porary diminution. 

In another series of cases of subjective noises, the cause must be sought 
outside of the nerve ; these are entirely iminfluenced by the galvanic cur- 
rent, whatever its direction and strength. 

There is also a third group, in which two kinds of noises are present at 
the same time, one of which is diminished by the current, the other en- 



XLSCTRIOAL EXAMINATION AND ELSOTBO-DIAGNOSIS. 99 

tirelj nninfluenced thereby. Hjpersesthesia is usually present in these 
cases, though not always in a pure form ; the former of these noises must 
probably be located in the nenre. 

We therefore possess in the galvanic examination of the auditory ap- 
paratus — on the one hand in the demonstration of galvanic hyperaesthesia 
of the auditory nerve, on the other in the determination of the sedative or 
stimulant action of the various factors of galvanic irritation upon the 
nervous tinnitus auriiun — a very important diagnostic aid in recognizing 
certain forms of this annoying affection as probably of a nervous character 
and in differentiating them from other forms. You will learn at a later 
period what important prognostic and therapeutic data are also furnished 
by this examination. 

We must regard as a further, though somewhat more rare, develop- 
ment of simple hyperesthesia : 

6. Oal'vanic hypercesthesia icUh anomaly and even reversal of the normal 
formiUa. In addition to the normal sensations of sound, other patho- 
logical ones occur, at first An CI and An D sensations, later Ca O sensation, 
all with the signs of hyperaesthesia. In almost all cases the newly devel- 
oped sensations are very clearly distinguished by their character and 
timbre from the normal sounds. Among themselves the pathological 
sounds correspond as completely as the normal sensations in healthy indi- 
viduals or the Ca CI and An O sensations in simple hyperaesihesi& 

The following case will serve as an illustration : 

A man aged fifty-four years. Chronic difficulty of hearing ; tinnitus 
aurium. Opacity and depression of tympanum. 

Left ear. External method of application, indi&rent electrode on the 
hand. 10 elements. 

Ca CI, shrill, loud whistling. 

Ca D, continuous whistling. 

Ca O, short humming noise. 

An CI, loud humming and roaring 

An D, gradually diminishing humming. 

An O, whistling as in Ca CL 

In addition, these new pathological sensations may gradually increase 
in intensity ; they appear earlier and more readily than the sensations 
produced by the normal factors of irritation, and these, on the other hand, 
grow weaker and weaker. Finally, the normal sensations may entirely 
disappear and the pathological ones alone remain, although the irritability 
is still increased ; the hypersesthesia is then attended with complete re- 
versal of the normal formula. 

The following personal case will serve as an illustration : 

A lady aged sixty years ; on the right side simple hypersesthesia, on the 



1 00 ELECTRO-THERAPEUTICS. 

left side bypersesthesia with reversal of the formula. Difficulty of hearing on 
the right side, complete deafness on the left Marked tinnitus aurium, 
especially on the left side. Old ear disease, formerly considerable dis- 
charge ; marked opacity and retraction of both membranse tympanL 

External method of application, the indifferent electrode placed in the 
hand. 

Right ear, 4 elements. Left ear, 6 elementa. 

Ga CI, loud whistling noise. 



Ca Dj continued whistling. 

Ca O, slight whisUing. 

An a, loud whistling. 

An D, continued whistling. 

An O, slight whistling. 



That is, a reversal of the normal formula on the left side, with somewhat 
less hypersesthesia than on the right Ca CI causes cessation of the tinnitus 
in the left ear, but this continues unchanged at An CI. 

These forms of hyperaesthesia with change and reversal of the normal 
formula occur, as it seems only in very severe and old diseases of the ear^ 
in serious affections of the middle ear, diseases of the labyrinth, and the 
like. In these cases, finally, the hy}>er8esthesia may diminish and disap- 
pear, and then the anomalies of the formula alone remain. We then 
speak of 

c. Qualitative anomalies of the galvanic acoustic reaction without hyper- 
CBSthesia, Under this head are included aU those anomalies which are 
not attended vnih special readiness of irritability of the acoustic nerve. 
All possible gradations may occur between the development of reaction to 
all six factors of irritation and simple reversal of the formula, addition of 
one or the other pathological reaction, absence of one or the other normal 
reaction, etc., so that the most varied formulae may be presented. 

It is by no means certain that all these anomalies develop from a pre- 
vious simple hypersesthesia ; it is not even probable, since an entire series 
of observations (for example, in rheumatic facial paralysis, central affections, 
injuries to the skidl, etc.) teach us that injuries and nutritive disturbances 
may occasionally act directly upon the auditory nerves in such a way that 
they react at once in an abnormal manner. Finally, mention should be 
made of the possibility that qualitative changes in the formula are perhaps 
induced by changes in the anatomical relations of the external parts sur- 
rounding the auditory nerves, so that threads of current, i. e. , the virtual 
pole, may reach the auditory nerve in another manner than in the normal 
auditory apparatus. 

These changes occur usually in old, more or less severe diseases of the 
ear ; they have also been observed with striking frequency in rheumatio 
facial paralysis, and occasionally in central afifectiona 



ELECTRICAL EXAMINATION AND ELEOtBO-DIAaJJOSiS. 101 

As a matter of course a different form of galvanic reaction may be 
fonnd in each ear, according as the aural affection is unilateral or varies 
on the two sides in kind, intensity, and duration. The skilled physician 
will have no difficulty in unravelling such a condition by careful examina- 
tion, and the greatest possible isolation of each ear during the examina- 
tion by the use of a branched electrode. 

I must finally add that we are warranted in accepting the idea of a con- 
dition of 

d. Torpor of the auditory nerve. This means a diminished galvanic 
irritability of the nerve. The nerve can be stimulated by very consider- 
able currents alone, then gives merely feeble Ca CI sensations, often none 
at alL 

You are aware that even under normal conditions galvanic stimulation 
of the auditory nerves is frequently unsuccessful : we must therefore be 
very cautious m adopting the notion of torpor of the acoustic nerve. 
This diagnosis can be made most readily in cases of unilateral diseai&e or 
when we can directly follow the gradual transition from abnormal readiness 
of irritability to pathological difficulty in evoking irritability, as occurred in 
one of my cases. 

Torpor of the auditory nerve generally occurs only in severe and in- 
curable disturbances of audition, although no definite relation can be de- 
termined to any anatomical changes which may be present. This anomaly 
is rare and recognizable with difficulty. 

8. With regard to galvanic stimulation of the nerves of taste nothing 
has hitherto been determined, under pathological conditions, beyond 
simple diminution or loss of the galvanic sensation of taste, which is readily 
recognized by the methods previously mentioned (page 65). 

Concerning the electro-diagnosis of the olfactory nerves, and also of the 
vasomotor and secretory nerves, the cervical sympathetic, the pneumogastric, 
the heart-mxiscle, bladder, xUerus, central organs of the nervous system, etc., we 
know nothing at the present time ; the observations hitherto made cannot 
be utilized practically. As a beginning worthy of notice we may mention 
the observations made by Hitzig on the reaction of paralyzed muscular 
fibres of the vessels. He found in several cases of paralysis of the axillaiy 
nerve that, in the region of circumscribed ansBsthesia of the skin caused 
thereby, the integument became entirely white upon stimulation with 
strong labUe galvanic currents, while ihe surrounding healthy portion 
acquired a purple color. Stimulation of longer duration, the application 
of a strong stabile galvanic current or of a faradic brush kept in one 
place, produced, on the other hand, more or less marked dilatation of 
vessels with the formation of wheals. Hitzig observed similar though less 
marked phenomena in other paralytic and trophic disorders, but the 
subject has not been investigated further. 












• • 



• • • 

• • • 



• • • 
• • • • 



• • 



• • • • 

•: : 



• • • • « • 



PART IV. 



GENERAL ELECTRO-THERAPEUTICS. 



LECTURE XII. 



The Therapeatio Value of Electrioii^ — ^Various Eleotro-therapeatio Theories— Bm* 
pirioal Standpoint — Utilisable effeots of the Current and the Method Employed — 
Stimulating, Modifjing (Refreshing), Catalytic Effects — Empirical Basis of the 
Latter — Direct and Indirect Catalysis— Therapeutic Oalvanization of the Ceryioal 
Sympathetic — Beflez Effects of the Current. 

Wk now turn to a consideration of the therapeutic Talae of electricify, 
to the estimation of its curative properties in the most varied forms of 
disease and thus to a determination of its practical therapeutic effects. 

We may state, unhesitatingly, that electricity is an extremely powerful 
and many sided remedy, and that more evident and tmdoubted curative 
effects may be attributed to it in diseases of the nervous system than to 
almost any other remedy. The experience of the last thirty years leaves not 
the least doubt that electricity is valuable in the treatment of neuralgia, 
anossthesia, spasms, and paralysis, in diseases of the peripheral nerves as 
in those of the central nervous system, and that its introduction into 
therapeutics has caused a more favorable prognosis in many forms of 
disease. I am not guilty of exaggeration when I say that the curative 
effects not infrequently astonish even the experienced physician by their 
magical rapidity and completeif^ss. 

Despite these facts, however, we know extremely little of a positive 
nature with regard to the finer processes in electrical curative effects, or 
their connection with the, to a certain extent, well-known physiological 
effects of electrical currents. 

The chief difficulties in this problem appear to me to lie on the 
pathological side of the question, viz., in our ignorance of the finer 
nutritive or molecular changes occurring in the nerves in various diseases. 
We possess scarcely any positive knowledge concerning the real nature and 
final causes of the so frequent inflammatory disturbances, degeneration. 



1 04 ELECTROTHER APEUTICS. 

atrophy, etc., of the tissues ! And how much less do we know conceming 
the more subtle processes in the various disorders of the nervous system, 
in neuralgias, spasms, paralyses and other manifold neuroses ! 

On the other hand, our knowledge of the various effects of electricity 
is by no means so extensive as many seem to think. We are accurately 
acquainted only with the irritating and modifying action of electrical 
currents upon the nerves and muscles ; conceming so called electrolytic 
effects upon the living animal we know practically nothing, and this is also 
true of so called cataphoric action ; with regard to our '* catalytic" effects, 
which are now referred to so frequently, it may be said that they are 
almost entirely hypothetical. 

And who will affirm that there are not other at present unknown effects 
of electricity upon the living organism, upon which the most important 
therapeutic results depend ? 

These remarks will suffice to give you an approximate idea of the real 
value of previous electro-therapeutic theories, and I will therefore make 
but a few statements conceming the most important ones. 

The greatest authority was enjoyed by the electrotonic theory, accord- 
ing to which the majority of the curative effects of electricity are due to 
its modifying action (increase or diminution of irritability). What ap- 
peared more natural than that neuralgia and spasms could be relieved by 
the sedative action of the anode, with production of anelectrotonus, an- 
aesthesia and paralysis cured by the exciting action of the cathode, with pro- 
duction of catelectrotonus ? But apart from the fact that we are not certain 
that an increase of irritability really occurs in the one group of cases, and 
a diminution in the other, it must be remembered that electrotonic action 
disappears very rapidly after the cessation of the current, while the cura- 
tive effects of the current are more or less permanent It may also be 
objected to the electrotonic theory that a purely polar action can scarcely 
be produced in a single nerve of the body (perhaps with the exception of 
the acoustic nerve). Under all circumstances it will be impossible to 
explain the manifold curative properties by electrotonic action alone, 
although a certain space in therapeutics must be reserved for such action. 

According to the stimulation theory, electricity acts merely as an irri- 
tant, and cure is effected by the various gradations of this irritant. But 
this theory does not advance us a single step further. At all events, it is 
no sufficient argument for this hypothesis that the electrotonic theory is 
unacceptable, and that apart from the electrotonic effects of electricity we 
are only positively cognizant of its action as a nerve stimulant. And how 
shall the stimulant action of the electrical current explain its manifold 
curative effects in the most varied affections, in those of a diametrically 
opposite character. We will see, at a later period, that a part, but by no 
means all, of the curative results can be explained in this manner. It is 
possible, however, that the electrical irritation of the trophic tracts and 



GENERAL ELECTR0-THERAPKUTIC8. 105 

oentares may modify the nutritive processes in the nerves, muscles, and 
other tissues, may further regeneration, remove finer nutritive disturb- 
ances, and thus cause recovery of morbid processes. It does not appear 
to me inconceivable that, for example, the undoubtedly favorable effect of 
methodical exercise upon the nutrition of the muscles is attributable to 
the IsLct that every motor irritation is associated with irritation of trophic 
fibres, and that the nutritive processes are thus stimulated. May not 
many curative effects of electricity be explained in a similar manner ? 

This view encroaches upon the domain of the theory of catalytic 
effects. The latter hypothesis attributes all electro-therapeutic results to 
a sum of effects among which the trophic effects mentioned are not ab- 
sent^ but which also include the action upon the blood-vessels and vaso- 
motor nerves, upon electrolytic and osmotic processes, and the mechanical 
effects of the current. I have previously stated (Lecture YL, page 56), 
that these ^* catalytic " effects are still hypothetical to a great extent ; it 
follows, therefore, that such effects can not .be made the basis of an electro- 
therapeutic theory, but at the most the starting-point for further investi- 
gations. 

We are thus compelled to acknowledge the deficiency of the theoretical 
basis of our electro-therapeutical knowledge ; now, as formerly, it must be 
studied upon an empirical basis. Only from a large number of further 
observations will we be enabled to gain, by degrees, a correct theoretical 
conception of electrical curative action. 

After these general remarks I will advert to those effects of the cur- 
rent which can possibly prove of value in therapeutics. I will briefly 
mention the purposes for which they can be utilized, and by what methods 
they can best be produced. 

The most frequently employed action of the current, and the one 
which admits of the most varied application, is the stimtdating, irritating 
effect. It is indicated under various circumstances, especi^y in peripheral 
but frequently also in central diseases ; in those cases in which we may 
expect to relieve pathological conditions by strong irritants ; when we 
desire to overcome resistances to conduction in the sensory or motor 
nerve-tracts by a vigorous condition of stimulation, or to renew the de- 
pressed irritability by frequent action of a stimulus ; furthermore, when 
we wish to stimulate the nutrition of the parts by action upon the trophic 
nerves, to effect circulatory changes by acting upon the vasomotor nerves, 
or to further the restitution of atrophic muscles by securing muscular 
contractions ; or finally, when we wish to act, from the sensory parts, in a 
reflex manner upon the central organs, and through these upon the vari- 
ous peripheral organs, upon vasomotor paths, motor nerves and muscles, 
respiration and circulation, etc. 

The methods by which these objects are effected follow readily from 
the remarks previously made ; the faradic current is introduced by means 



106 ELECTRO-THERAPEUnCS. 

of moist electrodes of a suitable shape and size when the deeper parts are 
to be stimulated ; by means of dry electrodes (best with a metallic bmah) 
when the nerves or other tissues of the skin are to be vigorously irritated ; 
the latter method is especially advisable to secure reflex effects. 

More nimierous methods may be employed for producing irritation hj 
the galvanic current ; most readily by cathodal closures, which may be re- 
peated with increasing strength and frequency ; anodal closure and open- 
ing are much less effective. An admirable method of obtaining irritating^ 
effects is by R Remak's labile action of the current, especially the labile 
action of the cathode. This is done in the following manner : the well- 
moistened Ca is moved up and down quite rapidly over the nerve-trunk 
or muscle to be irritated, with a strength of current sufficient to produce 
vigorous, wave-shaped contractions (a current which will produce Ga CI C 
in the same nerve is usually sufficiently strong). The vigorous stimulant 
effect of this irritation is due exclusively to the fad that, during the strok- 
ing movement, new parts of the nerve or muscle are successively brought 
into the domain of the electrode and thus of the greatest density of the 
current, and are thereby stimulated. A labile effect can also be produced 
with the anode, though not so powerfully as with the Ca. Remak has ap- 
plied the term ** terminal labile stimulation " to stroking with the Ga over 
those parts of the long muscles situate<l nearest to the tendinous ends, the 
current being allowed to pass, as &r as possible, throughout the entire 
length of the muscle. 

The most vigorous method of irritation is rapid change of polarity, 
especially to Ca after the An has been allowed to act for some time. 
Frequent repetition of these changes of polarity is often the only manner 
in which contractions can still be produced in markedly atrophic muscles 
with very much diminished irritability. 

The site at which these applications must be made naturally depends 
upon the location and character of the disease, and also upon the object 
to be attained. I will merely remark that, in order to overcome obetadee 
to conduction in the nerve-paths, the stimulation of the sensoiy nerves 
should be performed peripheraUy from the site of the lesion, that of the 
motor nerves as central as possible ; the stimulation of degenerated and 
atrophic nerves and muscles must be effected upon these organs them- 
selves. 

The modifying, irritabiliiy-changing effects of the current are also very 
often required. In feet there are a number of cases in which we may ex- 
pect a favorable result from such action ; whenever we assume a diminu- 
tion in the irritability of the nerves and muscles, in certain paralyses and 
anaesthesia, in certain vasomotor affections, even in certain conditions of 
depressed spinal and cerebral activity, we are justified in resorting to the 
catelectrotonic action of the current (stimukting, strengthening, anti- 
paralytic, refreshing action), while the anelectrotonic action of the current 



OKNBBAL ELKOTRO-THEEAPBUnCS. 107 

should be resorted to in increased irritability of the nerves and muscles, 
irritatiye conditions in ike sensory, motor, and vasomotor tracts, and also 
abnormal conditions of irritation in the central nervous system, i.^., in 
neuralgia, spasms, puncta dolorosa, spinal irritation, headache, insomnia, 
hypersesthesia of the acoustic nerve, angiospastic migraine and the like. 

The methods employed to secure these effects are very simple. They 
are uncertain with the faradic current, concerning whose modifying effects 
yeiy little is known ; it is usually held that feeble faradic currents pro- 
duce increased irritability while very powerful currents diminish the irrita- 
bility. This has been inferred chiefly from pathological and therapeuti- 
cal dfttft- 

Diminution of irritability is also secured in many cases by the so-called 
increasing induction current: the large, moist electrodes being held in 
one position, the faradic current is first allowed to pass in a very feeble 
current and then gradually increased to the greatest strength which may 
be tolerated ; it is retained at this height for some time and then slowly 
diminished. This procedure may be repeated several times at one sitting. 

The modifying effects can be obtained more positively by the galvanic 
current To produce increased irritability, the Ca should be applied in a 
stabile manner with increasing strength and duration ; even after the ctir- 
rent is opened, a positive modification of irritability persists for some time. 
The stabile application of the anode is the most suitable method for 
diminishing irritability ; increasing strength and duration of the current 
likewise produce an increase of the desired effect. But a new difficulty 
here arises ; with the opening of the current, after the cessation of an- 
eleotrotonus, a considerable increase of irritability occurs, and thus puts 
in question the entire result of the previous application. We must 
endeavor to obviate this ; as it seems to me, this can be done with con- 
siderable certainty by carefully and gradually diminishing the strength ol 
the current until it has sunk to niL 

In discussing the individual forms of disease I will formidate more in 
detail the special modifications of this method of treatment Among the 
modifying effiects must be included those which Heidenhain has described 
under the term *' refreshing action '* of the galvanic current. It is best 
secured by ascending stabile currents, depends probably in great part 
vcpon the electrotonic action of the Ca, and may be employed in those 
cases in which exhaustion of the motor apparatus has developed from over- 
exertion, excesses, and the like. 

However obscure the catalytic effects of the current may be, their ex- 
istence and extremely manifold applicability are universally recognized. 

I have previously described them in detail (Lecture VL, page 56) and 
need merely repeat in brief what is meant thereby : they are the effects 
upon the vasomotor nerves and blood-vessels, probably also on the lym- 
phatic vessels and the lymph current ; the effects upon osmotic processes, 



108 ELECTRO-THEBAPEUnCS. 

molecular arrangemeDts, movements of fluids iu the tissues, the electn>- 
lytic and cataphoric effects, perhaps also the effects upon the trophic 
nerves — in short, the influences resulting from all these upon the pro- 
cesses of resorption and nutrition in general In fact, a sum total of effects 
which must secure to the electrical current an extremely powerful and 
many-sided influence upon various morbid processes in the nervous system 
as well as in the other tissues of the body. Thus, in all inflammatory dis- 
turbances of an acute and chronic character (neuritis, myelitis, sclerosis, 
etc.), in the most varied exudative processes, in rheumatism of the joints, 
muscles, and nerves, extravasations of blood, all kinds of degenerative 
changes, palpable and impalpable nutritive disorders of the nervous system. 

Although the existence of these effects cannot be denied, we are far 
from being able to secure them with certainty and equally far removed 
from designating those forms of disease in which it may be assumed 
that these catalytic effects will prove successful 

I will now mention a number of pathological and therapeutical observa- 
tions which bespeak the existence and pathological significance of these 
catalytic effects and present, to a certain extent, a positive basis for the 
criticism and further investigation of this interesting question. 

In the first place we may refer to the results of galvanic treatment in 
the various forms of neuritis. B. Bemak mentions several cases of pri- 
mary and secondary neuritis and also of neuritis nodosa in which the pain 
and swelling disappeared more or less rapidly upon application of the gal- 
vanic current : Mor. Meyer observed very rapid disappearance of neuritis 
of the median nerve, with perceptible swelling, under stabile action of the 
anode, and lately reports similar results in taiumatic neuritis and other 
forms. Fr. Fischer and I have reported similar cases. 

The observations in arthritis of various kinds are more numeroua 
Bemak mentions a number of brilliant results in acute and chronic rheu- 
matic and traumatic affections of the joints, which leave scarcely a doubt 
of the decided antiphlogistic action of the galvanic current. Various 
other writers have described very favorable results in chronic exudations 
into the joints, and other diseases of this clasa 

M. Bosenthal observed several cases in which chronic exudations into 
the joints disappeared under galvanic treatment ; Moritz Meyer reports 
several cases in which favorable results were obtained, partly by faradiza- 
tion, partly by galvanization ; Cohen obtained good effects in true arthritis 
from persevering treatment with the rotatory apparatus, and similar success 
is reported by Cheron from the galvanic treatment of deforming articular 
rheumatism ; Weisflog noticed striking results from local faradization of 
traumatic and scrofulous inflammations of the joints, and regards this cur- 
rent as " the most vigorous, unfailing, and valuable antiphlogistic for all 
traumatic inflammations." 

Furthermore, resolution and atrophy of glandular tumors have been 
repeatedly effected by electrical currents. Onimus and Legros mention 
one noteworthy case in which two symmetrical glandular tumors were 
present, one of which was treated with the An alone, the other with the 
Ca alone ; the one treated with the An disappeared more rapidly. 



GENERAL ELECTRO-THERAPEUTICS. 109 

Moritz Meyer has effected a separation and reduction in size of mul- 
tiple, large, hard glandular tumors hy the application of very strong, fre- 
quently interrupted faradic currents ; Chvostek has treated many strumous 
growths with the stabile galvanic ciirrent, and effected often a consider^ 
able diminution in their size, in some cases very rapidly and completely. 

No less striking are the results which some observers have obtained in 
hard cicatrices, stii&ess of the joints and periostoses after gunshot wounds, 
by means of the galvanic current. 

Finally, observations have been made upon evident action of the cur- 
rent in contusions, extravasations of blood, subluxations, and inflamma- 
tions. Bemak saw a brilliant result in a sprain of the wrist-joint in which 
the swelling and stiffness rapidly disappeared. Chvostek relieved a 
chronic inflsunmatory, traumatic infiltration of the leg by means of labile 
galvanization of the nerve. Sycianko states that he repeatedly cured 
acute gingivitis in a remarkably short period by the action of the anode ; 
and Charon and Moreau-Wolf maintain that they have had very favorable 
results from the galvanic current in gonorrhoea! and traumatic inflamma- 
tions of the testicles, and in chronic hypertrophy of the prostate. 

There can be no doubt that similar effects, though to a less degree, may 
be produced even in more deeply situated tissues, but it would lead us 
too far to mention all the observations of palpable diseases of the brain 
and spinal cord in which undoubted favorable results were obtained from 
the catalytic action of the electrical current. 

At all events, there is no doubt that such action exists, though its more 
intimate character is still involved in great obscurity. Catalytic effects 
are produced in the main by the galvanic current, and upon this fact de- 
pends, no doubt, its great superiority to the faradic current, especially in 
the treatment of more deeply situated organs. 

The best method of securing the catalytic effects of the galvanic cur- 
rent appears to be its stabile passage through the diseased part (with suf- 
ficient strength and duration of the current). It is probably useful to alter 
the direction of the current several times, as the vasomotor, electrolytic, 
and cataphoric effects of the current are undoubtedly intensified thereby. 
The position of the electrodes depen4B entirely upon the situation and 
size of the diseased part : if we have to deal with a small neuritic nodule, 
it may be entirely covered with one electrode, the other being placed 
upon an indifferent part of the body ; if we have to deal with a diseased 
joint or a morbid process in the brain, the electrodes are placed on each 
side of the diseased part 

You will naturally ask whether the two poles do not have different ef- 
fects and whether one or the other does not deserve the preference in 
special cases ; d priori, this view is very probable, but we possess no posi- 
tive evidence of its correctness. 

It is generally held that the application of the anode to the diseased 
part is preferable when there are symptoms of active irritation, more 
active processes, abundant collections of fluid, very painful affections ; 



110 ELEOTRO-THER APEUnOS. 

while the cathode should be applied to more torpid, chronic processes, 
indurations, scleroses, etc. But as many data favor an opposite view, or, 
at least, seem to indicate that the polar effect comes less in question than 
the direct passage of the current, I have preferred, as a rule, to place 
both poles upon the diseased part, and then change the direction of the 
current several times, or, in the unipolar application, to allow first one pole 
and then the other to act. 

From theoretical considerations Chvostek arrives at the conclusion that 
short and not too strong currents may alone be employed (about three to 
ten minutes) ; he attributes the catalytic effects chiefly to stimulation of 
the vasomotor and trophic nerves ; he regards it as preferable to treat the 
iiseased part directly, and not alone the corresponding nerves, in order to 
take advantage also of the electrolytic and cataphoric actions of the 
2urrent. 

In many cases it also appears useful, in addition to treatment of the 
diseased part itself, to make a stabile and labile application to the adja- 
cent parts — vessels, lymphatics, muscles, skin — in order to act indirectly 
upon the circulation and nutrition of the diseased parts ; repeated inter- 
ruptions of the current and even changes of polarity may be useful, in 
order to intensify the individual effects of the current, to relax tense mus- 
cles, etc. ; these measures are especially advisable in the treatment of 
diseased joints. 

The faradic current is much less effective for catalytic purposes ; more 
or less powerful currents are simply passed directly through the diseased 
pari In the resolution of glandular tumors, M. Mayer has employed the 
faradic current in such a manner that the strongest possible current 
(with moist electrodes) is applied for a few minutes, frequent interruptions 
being made during this period ; a distinct separation of the tumor into 
smaller parts occurs forthwith, and the tumors are gradually reduced very 
much in size. B. Bemak has also described an indirect catalysis. It is 
said to consist in a modification of the circulatory and nutritive conditions 
of various tissues, produced by galvanization of the nerve-trunks supplying 
them. Bemak states that he has seen galvanization of the nerves, remote 
from the site of disease, cause more rapid absorption of extravasations of 
blood, disappearance of articular swellings, increase in the size of atrophic 
muscles, etc. ; he recommends the application of the anode to the nerve- 
trunk, as far as possible from the site of disease, as an especially certain 
remedy in relieving the pain of inflamed parts, joints, etc. It would be 
very desirable, however, that these isolated observations should be con- 
firmed and multiplied in order to place the doctrine of indirect catalysis 
upon a surer basis of fact. 

This question has assumed an unexpected importance from a series of 
statements and hypotheses concerning galvanization of the cervical sym- 
pathetic as a therapeutic method. It has been said that this method of 



GENERAL ELECTBO-THERAPEUTIOS. Ill 

application influences the yasomotor and trophic processes of the brain 
and spinal cord, the face and eye, the muscles and joints, even the skin 
and other parts of the body. Numerous cures have been reported by this 
method in cerebral hemiplegia, trigeminal neuralgia, migraine, paralysis 
and spasms in the distribution of the facial nerve and in the ocular muscles, 
in bulbar paralysis ; also in neuro-retinitis and atrophy of the optic nerve, 
Basedow's disease, epilepsy, progressive muscular atrophy and lead paraly- 
sis, arthritis deformans, scleroderma, and various other diseases of the skin. 

There can probably be no doubt of the correctness of a part of these 
observations, but this does not by any means imply that the cervical 
sympathetic is responsible for such results. In the ordinary methods of 
g^vanization of the sympathetic, numerous threads of current undoubtedly 
reach the pneumogastaic, carotid, the nerves at the base of the skuU, the 
brain, the brachial and cervical plexuses, but especially the cervical region 
of the spinal cord, and the medulla oblongata with their numerous impor- 
tant centres for the vessels, pupils, respiration, the hearty nutrition of the 
muscles and joints, eta ; it is a question whether these effects are not 
more important than those upon the sympathetic. 

I attach no great significance to the fact that physiological experi- 
ments upon the cervical sympathetic of healthy individuals (page 51) have 
been so barren of results with regard to the therapeutic application of 
this method. In such matters experience can be our sole guide in prac- 
tice. The negative results of physiological experiments, in opposition to 
positive therapeutic facts, should not prevent us from employing so-called 
galvanization of the sympathetic as a therapeutic measure and testing its 
value. I am in favor of employing the term '' galvanization of the neck,*' 
instead of " galvanization of the sympathetic," or better still, the term 
" subaural galvanization " recommended by De Watteville. 

The most serviceable method of application is that recommended by 
Mor. Meyer ; one pole (a '* medium *' electrode) is applied under the angle 
of the lower jaw on one side, immediately adjacent to the hyoid bone, and 
is pressed backward and upward kgainst the vertebral column ; the 
other somewhat larger electrode is applied to the opposite side of the 
neck near the spinous processes of the fifth to seventh vertebra?. The 
Ca is usually placed in the former position (region of the superior cervical 
ganglion). The employment of moderately strong currents is usually 
sufficient (6 to 10 Stoehrer's elements), a stabile current is generally 
used, but labile and interrupted currents, even changes of polarity, are 
sometimes indicated. The duration of the application need not, as a rule, 
exceed one to three minutes. According to the circumstances of the case 
it is made unilaterally or bilaterally. 

Benedict places a button-shaped An in the jugular fossa, the Ca upon 
the superior cervical ganglion ; for anatomical and physical reasons this 
method is not as serviceable as the one just mentioned. 



112 ELECTBO-THEBAPEUTICS. 

Finally, I will make a few remarks concerning certain reflex effects of 
electrical currents ; I refer to changes in the vessels of the brain and 
spinal cord from faradic or other irritation of the skin and peripheral 
nerre-trunka Contraction and dilatation of the vessels of the pia mater 
in the brain and cord have been observed, though not constantly, after 
irritation of peripheral nerves and organs. Probably a part of the results 
of peripheral electrization in diseases of the central organs must be attrib- 
uted to such effects, and Bumpf has recently described a few cases in 
which peripheral cutaneous faradization apparently had a veiy favorable 
influence upon central hyperemias, optic neuritis, locomotor ataxia, etc. 
The method employed by him consisted of slow stroking of a faradic brush 
to the chest, back and arms, with a moderate current, the sitting lasting 
five to six minutea 

From the above considerations you readily see that our theoretical 
views concerning the therapeutic applications of electricity are still defec- 
tive and insufficient. We are confronted by a number of problems, toward 
whose solution merely tlie first steps have been taken ; our most import- 
ant problem still is to develop electro-therapeutics by empirical means. 
We may console ourselves, however, by the undoubted practical results 
which are achieved and by a glance at other branches of therapeutics and 
our ignorance of the method of action of the most valued remedies. Are 
we not unacquainted with the manner in which quinine relieves chills and 
fever, in which salicylic acid relieves acute articular rheumatism, and 
iodide of potassium tertiary syphilis ? And so in electrotherapeutics tiie 
number of our successes should spur us on to continued investigation. 



LECTURE Xin. 

Kethocbi of Thenpentio AppUoatlons in Local Diseases— Polar or Direction Method f-^ 
Advantages of the Polar Method — Empirical Methods — Inflaenoe upon the Gen- 
eral Ori^mism : 1. General Faradisation (according to Beard and Rockwell) ; 2. 
General Galvanisation; 8. Central (Galvanisation (Beard); 4. The Electrical 
Bath— Special Methods of Treatment: 1. Galvanic Treatment of Pressure and 
Painful Points ; 2. Treatment with Feeble, Gontinaons, Galvanic Currents. 

A uvELT dispute has arisen with regard to the question whether the 
direction of the current or the polar action should be taken as the general 
basis for the method of application. 

Brenner first deyeloped the well-founded polar method, according to 
which the action of the individual poles, and therefore the localization of 
one or the other pole upon the diseased part was decisive for the electro- 
therapeutic method. 

Neither of these two methods was applicable with strict consistency, 
and theoretical considerations alone were opposed exclusivelj to one or 
the other ; indeed, a superficial glance sufficed to show that certain fields 
of the electro-therapeutic effects were very little or not at all affected by 
this dispute. What could be accomplished, for example, by the direction 
of the current in the treatment of glandular tumors, struma, joint inflam- 
mations and the like ? 

It is, however, a matter of some interest to us to enter into this ques* 
tion and to weigh the arguments for both methods, pro and con, in order 
to form a decided opinion for our future conduct. 

With regard to the direction of the current we know, in the first 
place, that in the majority of cases it is impossible to pass the current ef- 
fectively in a definite direction through a nerve of the uninjured body, but 
that necessarily at least three different directions of the current (of rapidly 
diminishing density) must be present ; this has previously (page 37) been 
proven in detail. The only conceivable method of application by which 
one definite direction of the current is possible, at least in some parts of 
the nerves, viz., that in which the current is conducted from the end of a 
limb (hand or foot) to a more central part of the extremity or to the 
trunk, would only suffice for the peripheral halves of the nerves ; but care- 
ful consideration will show that in the neighborhood of the central elec- 
trode (centrally from it, especially when placed on the trunk) diffused cur- 
rents of varying direction are unavoidable ; this method of application, in 
8 



114 ELECTRO-THEE APEUTICS, 

addition, would be applicable only in the fewest cases. The adyocates of 
the *' direction *' method must therefore devise other modes of application 
in order to bring the direction of the current exclusively into action. 

Furthermore, all proof is lacking that the direction of the current is at 
all an essential factor in its action. On the contrary, the investigations of 
physiologists have proven that all the known effects of the current (stimu- 
lating, modifying, electrolytic, etc.) are exclusively polar effects, and come 
into play in any direction of the current (with the single exception of its 
strictly transverse passage). In fact, the direction of the current appears to 
be devoid of any decisive influence upon the occurrence of the polar effBcts. 
In only a few definite cases (third stage of Pflueger's law of conlaraction) is 
the conduction of the, nevertheless developing, irritative process inhibited 
in one or the other direction ; but this cannot surely be interpreted as a 
" direction " effect It is decisive in this respect, that the inhibition of con- 
duction occurs sometimes with ascending, sometimes with descending cur- 
rents, that it occurs in the sensory nerves in an opposite direction of the 
current to that in the motor nerves, and that it may be attributed to cer- 
tain polar effects. 

There appears, therefore, to be no reason for making the direction of 
the current the basis of our method of application ; at all events, there is 
no scientific necessity for it, although a regard to technical practicability 
and, in some cases, certain surmises may induce us to employ such a 
method. 

On the other hand, there are very weighty reasons for preferring the 
polar method, reasons of a physiological and physico-technical character, 
but also those which result from therapeutical experience. 

In the first place, physiology has shown that all the recognized, 
therapeutically useful actions of the current are exclusively polar effects, 
and appear to be associated with the vicinity of one or the other pole ; in 
general, all effects of the current are most intense in the immediate 
vicinity of the pole. 

In the second place, it is technically much easier to subject any desired 
part of the body to the most intense possible action of one or the other 
pole, than to cause a definite direction of the current of uniform intensity. 
With the aid of accurate anatomical knowledge and the proper choice 
of the active and indifferent electrodes, this purpose can almost always be 
effected with readiness and certainty. One serious objection, however, 
cannot be escaped ; an exclusive action of one pole upon a definite part is 
impossible, as we have previously seen ; the effect of the other pole must 
always be present at the same time. But if you will remember how the 
currents are diffused, what a slight degree of density, and therefore of 
activity, they must have in by far the majority of cases, it will not be 
difficult for you to believe that the action of the ** active " pole must be 
extremely predominant, in comparison with which the secondary polar 



GENEBAL ELECTROTHERAPEUTICS, 115 

action may, in the majority of cases, be neglected ; furthermore, the latter 
may be diminished bj suitable manipulation and the primary polar action 
be allowed to affect the nerve in an increased measure. 

In addition, there are a certain number of therapeutical data which 
furnish proof of the efficacy of the polar method. The most striking 
are the facts observed with regard to nervous tinnitus aurium and 
hypersBsthesia of the acoustic nerve ; in these cases the pole indicated by 
the formula of galvanic reaction usually proves highly effective in the 
relief of the tinnitus as well as in the diminution of the hypersBsthesia^ 
while the other pole is ineffective or even injurious. Hoist has developed 
a galvanic treatment of migraine according to the principles of the polar 
method, and the successful results corresponded to his assumptions ; O* 
Berger ascribes brilliant results in trigeminal neuralgia to the application 
of the strict polar method (stabile application of the An) ; Althaus has 
successfully employed the polar method in toothache and also in other 
neuralgias. 

But the decisive feature in this question must be the main purpose, 
according to our present knowledge, of all electrical treatment, viz., to 
subject the diseased part as certainly and as intensely as possible (avoid- 
ing all injurious auxiliary effects) to the action of a current of sufficient 
density. 

As we are unfortunately ignorant, in the majority of cases, of the 
manner in which the electrical current acts, we must at least see to it that 
it does or may act 

But, in the end, experience alone can teach us whether one pole (and 
which one) will prove especially effective ; a priori we will only be able to 
predict this vnth certainty in a limited number of cases. We should not 
be astonished if phenomena are occasionally observed which are opposed 
to our theories. In not a few cases you will find both poles effective in a 
similar manner, and, especially in the production of catalytic effects, it 
has hitherto proved impossible to give the preference to one or the other 
pole and to define their effects more accurately. 

From all that has been said it appears probable that the direction of 
the current does not possess great influence upon any therapeutic result, 
but this is by no means proven. In this matter, also, further experience 
must decide the question. In many cases, indeed, a definite direction of 
the current may be useful to facilitate the action of one or the other pole, 
but this is only done in the service of the polar method. 

It is evident that we have to deal in the main with empirical methods- 
I cannot warn you too strongly against illusions based upon theoretical 
views or against therapeutical illusions founded upon uncontrolled observa- 
tions. Electro-therapeutic literature swarms with such instances and the 
defective criticism of observations has led to innumerable, unsuspected 
deceptions. 



116 ELEOTBO-THERAPEDTICS. 

The TemarkB which have been previously made hold good esaentiaUf 
vith regard to the local treatment of local diseasea. 

But mention must be made also of a few other measures whose object 
it is to influence the entire organism — methods which have been devised to 
combat certain forms of disease in which there is a general disturbance of 
the entire nervous system (as in various forms of neurasthenia, hysteria, 
hypochondria, etc.), or in which an affection of the blood and nutrition 
produces general weakness of the organism (an^pmia, chloroaiB with ita 
nervous disorders, general muscular weakness, etc) ; or, finally, those 
forms of disease in which we endeavor by stimulation of the entire oi^^- 
ism, especially the muscular system and aldn, or by an electrical influenoe 
upon the entire nervous system, to combat wide-spread, deeply seated, or 
certain peculiar disturbances (general weakness, hysteria, diffuse vaso- 
motor paresis, diffuse affection of the skin, multiple diseases of the joints, 
etc. ). There is no doubt that favorable results 
are often obtained by these methods. 

1. General faradiaUion (first employed by 
Beard and Rockwell). It purposes the most 
general faradic stimulation possible of the en- 
tire organism, with special preference of the 
central nervous system, the muscular system, 
and the skin. 

The foUowing is the method ; the patient, 
undressed in great part or lightly clothed, is 
seated upon a chair, the bare feet being placed 
tTadewitiiiwtuDdia.ni>MtnR«Mni upou 8 Urge, flat, weU-molsteued electrode 
(or in a vessel filled with lukewarm wat«r), 
which is connected with the Ca of the secondary coiL The Anode is 
either formed by the moist hand of the physician (who takes the electrode 
in the other hand and allows the current to pass through his own body), 
or, better still, by a large sponge-covered electrode (6 to 8 ctm. diameter) 
(Fig. 26), which is brought in contact, as far as possible, with all parts of 
the body. In sensitive persons the " electrical hand " is advisable in appli- 
cations to the forehead, head, and anterior parts of the neck, because the 
physician then has an excellent gauge of the strength of the current and 
because this method of application is vei^ mild on account of the great 
adaptability of the hand. 

We begin with the forehead, allovring a distinctly perceptible current 
to pass through it and the temples, and then pass to the vertex, where the 
An is allowed to remain for some time ; a somewhat stronger current is 
then applied to the occiput and back of the neck ; a still stronger current 
is then applied for some time along the spinal column, along which the 
electrode is slowly moved up and down, being kept a little longer upon 
special points, such as painful spinous processes ; this is followed by fara- 



GENERAL ELECTRO-THEBAPEUTICS. 117 

dization of the neck (with a weaker current) in order to stimulate the • 
sympathetic, pneumogastric, and phrenic nerves and the muscles of the 
neck ; then the anterior surface of the chest, especially the cardiac region, 
and the abdomen are faradized with more vigorous currents ; the An may 
remain for some time upon the epigastrium in order to affect the coeliac 
plexus, and is then slowly passed over the entire abdomen in order to stim- 
ulate intestinal action and the abdominal muscles ; finally, the muscles 
and skin of the back and all four extremities ai-e vigorously stimulated in 
succession ; the electrode is forcibly drawn over all these parts, especially 
the main nerve-trunks and muscles, with such a strong current that ac- 
tive muscular contractions develop everywhere ; at the close, the spine may 
undergo a second brief application. 

The entire procedure should occupy about ten to twenty minutes, and 
must naturally be varied extremely in intensity, duration and the special 
localizations of the current in different individiials and forms of disease. 

Beard and Rockwell ascribe to this method the following effects : the 
immediate effect, as a rule, is refreshing and stimulating ; pains, general 
weakness, etc., disappear temporarily ; the pulse is regulated ; in very 
sensitive persons, dizziness, nausea, trembling, feeling of faintness may 
develop. Within one to three days after the application certain reactive 
symptoms may occur — muscular pains, increased nervousness, headache, 
insomnia, etc. 

The permanent effects usually consist of improved sleep, increased ap- 
petite, improved digestion, increase in the size and firmness of the mus- 
cles, relief of pain and dulness in the head, etc., diminution of nervousness 
and depression. Beard and Eockwell attribute these effects to direct elec- 
trical stimulation of the entire central nervous system and the frequently 
repeated vigorous muscular contractions during the applications. 

According to these writers, this method is indicated especially in " con- 
stitutional diseases," in all forms of disease associated with general feeble- 
ness of nutrition and the vital functions (for example, in neurasthenia, 
hysteria, hyx>ochondriasis, nervous dyspepsia, ansemia and chlorosis, paraly- 
sis and neuralgia from constitutional causes, fiuihermore in certain func- 
tional disorders of the sexual and digestive organs) ; abo in morbid symp- 
toms, whose probably local cause cannot be recognized (as in many cases 
of neuralgia and paralysis, epilepsy, hysteria, et<3.) ; finally, in diseases 
which, though themselves incurable, are associated with general feebleness 
of nutrition and other symptoms (insomnia, nervousness, weakness, etc.), 
which may be relieved. 

I have employed general faradization with sufficient frequency to satisfy 
myself of its decidedly favorable effects. 

2. General galvanization is the exact analogue of the previous method, 
except that the galvanic current is employed ; the Ca is applied to the 
feet, and the An manipulated upon the body of the patient in the manner 



118 ELBCTRO-THERAPEUnCS. 

which I have described for general faradization. The efifects are said to 
be similar, but greater caution must be employed in applications to the 
central nervous system. 

3. Central galvanization, A large flat Ca is placed upon the epigastrium, 
while the An is applied by means of a large, round sponge-electrode to the 
head, the sympathetic, and along the entire spinal column. The forehead 
is first stroked gently from one side to the other with a feeble current (2 
to 8 elements), and then an appUcation made for one to two minutes to the 
centre of the skull ; the An is then moved up and down for one to five min- 
utes along the sympathetics and pneumogastrics in the neck, finally in the 
same manner along the entire spinal column for three to six minutes. 

This method is said to be especially applicable in those neuroses in 
which the general nutiition and muscular power are relatively intact 
Beard states that he has seen brilliant results from it in hysteria, hypo- 
chondriasis, chorea, cerebral and spinal neurasthenia, gastralgia, nervous 
dyspepsia, etc. 

I have employed this method in a few cases, without observing any 
notable result, but I do not consider this a sufficient test The results 
reported by Beard are so remarkable that we are justified in expecting 
from their confirmation the solution of various theoretically important 
questions. 

4. Finally, I will briefly mention another method of general eleotrizatioa 
of the body viz., the electrical bath. 

In one variety, the metallic bath-tub is connected with one pole while 
ihe other pole is grasped by the hands of the patient Care must be taken 
that the body of the patient does not come in actual contact with the meta 
of the bath-tub ; this object is secured either by means of a wooden sup- 
port or by some other arrangement which supports the body in the water. 

In another form, the bath-tub consists of a non-conductor, and the elec- 
trodes are placed in the water. The individual parts of the body will be 
subjected more or less intensely to the action of the current, according to 
their approximation to the electrodes. In order to introduce the greatest 
possible quantity of electricity into the bath, very large electrodes should 
be employed, or an addition of salt^ soda, or add may be made to the 
water used in the bath. 

The temperature of these baths may be varied according to the general 
indications of the case, and this is also true of the strength of the current 
to be employed ; usually at least a slight sensation of the current should 
be felt. The duration of the bath varies from ten to thirty minutes. 

Local electrical baths have also been employed, one electrode being 
represented by a basin of water in which the diseased part is immersed. 

A priori, it cannot be denied that the electrical bath may produce very 
marked effects, but the therapeutical experiences hitherto obtained are not 
calculated to inspire great faith in its efficacy. It appears to have been 



GENERAL ELECTBO-THERAPEUTIOS. 119 

most succeesful in certain forms of tremor, especially mercurial and al- 
coholic tremor, then in chronic articular rheumatism, in cerebral neuras- 
thenia. 

In conclusion I will refer to two other methods of treatment which are 
capable of general application. 

1. The first is the galvanic treatment of pressure and painful points, 
i.e,y of pressure points which, perhaps more or less painless in themselves, 
have an evident effect upon the production or relief of neuralgias and 
spasms ; or of painful points which are revealed by pressure with the 
finger or electrical examination and are found associated with the other 
symptoms of spasms, neuralgia, locomotor ataxia, and the like, without 
producing upon pressure any notable influence upon the momentary con- 
dition of the symptoms. 

B. Bemak found these points upon or near the spinal column in some 
neuralgias, and also in the neuralgiform pains of ataxics, and often ob- 
served a magical sedative influence from the stabile application of the An 
to these points. He also observed this in many forms of spasm, especially 
facial spasm, when he directed the current to points, pressure upon which 
produced inhibition or increase of the spasm, and which were often found 
more or less remote from the affected nerve-tnmk, especially upon the spine. 
Onimus and Legros report similar observations in ataxia. Mor. Meyer 
found these painful pressure points, in a large number of neuroses, upon 
the spine (the spinous processes, more frequently the transverse processes). 
He believes that they are due to various anatomical lesions (periostitis, neur- 
itis, small glandular tumors, inflammatory exudations, etc.) and often pro- 
duce and maintain the neurotic symptoms ; he has found that their galvanic 
treatment with the An is an excellent therapeutic remedy in neuralgia, 
spasms (chorea, writer's spasms), and even in ataxia. He has recently ob- 
served such pressure points in the nerve plexuses or other parts of the coiu:«e 
of the nerve, and has corroborated his former experience with regard 
to the fevorable action of the An. He recommends beginning the treat- 
ment with weak currents (4 to 8 elements). 

Brenner has found such painful points upon the spine by passing the 
Ca (of a mild current) down the vertebral column. Upon passing over 
some points the patients experienced intense pain, and persistent applica- 
tion of the An to these parts causes them to disappear gradually, and usu- 
ally leads to relief of the neuralgia, disappearance of the cincture feeling, 
and marked improvement of the ataxia. 

I have not detected similar phenomena, except in rare cases of ataxia. 

The best method of treating these points appears to be the stabile ap- 
phcation of the An, vnth feeble or moderately strong currents. The Ca may 
be applied to an indifferent spot or to more peripheral painful points, 
according to the circumstances of the case ; the application should be con« 
tinned from one to five minutes. 



120 



ELECTUO-THERAPEUTICS, 



2. The other method is that of treatment with very feeble but very pro- 
tracted uninterrupted galvanic currents. Currents of one or two, at the most 
four, elements are applied to the diseased part continuously for hours, or 
even for days and weeks. 

Among more recent writers Ciniselli was the first to recommend the 
appHcation of a " simple element " (a adnc or copper plate, connected by 
an insulated wire, vide Fig. 27) to the skin for the relief of various ner- 
vous affections. The plates may be of various sizes, must be thin and flex- 
ible, brightly polished before each application, and are fastened to the de- 
sired spot by means of adhesive plaster or a bandage. Their action is 
intensified by applying to the plates a piece of linen, which is kept con- 
tinually moistened by a solution of salt or acid. 

These plates must be applied several hours a day, or even continuously 
for days and weeks. If the skin is very sensitive, inflammation and pus- 
tules may develop beneath the plates ; their point of application must 




~UWrD5U^J#\~ 



Fio. 27.— "Simple dement" nccordlng to Cinis^lH. a, Zinc pTate (»nteri'»r aspect); ft, oopper plat* 
(poflterior a«i»ect), connection by mrans of an insulated copper wire : r, point at which the wire is nol- 
dered ; <t, •raaU button around which the wire is wound to prevent breaking. 

then be changed often, and the period of employment diminished. Cini- 
selli found such apparatus serviceable in neuralgia, paralysis, headaches, 
and the like. 

Le Fort*s method consists in the application of a current from two to, at 
most, four elements, which is conveyed to the diseased part by means of or- 
dinary electrodes, and is employed for days and weeks, either continuously 
or with short intermissiona Le Fort considers these weak currents in- 
dicated in all paralyses and pareses with simple or fatty atrophy of the 
muscles, in reflex paralysis from contusions, in all conditions of poor nu- 
trition of the muscles, and finally in contractures. 

Valtat has obtained striking results from this method in the atrophies, 
pareses, and paralyses of muscles which are so extremely frequent after 
joint affections. The treatment should be instituted after tlie acute in- 
flammatory sta^e has cea.sed and a chronic condition developed. At a later 
period, f^^radization of the niusolos miy also be employed. I have also ob- 
tained some good results from this method ; it was especially successful in 
a number of cases of severe hysterical neurasthenia of delicate women with 
marked muscular weakness, and in whom the element was applied sev- 
eral honra daily to the back. It is difficult to determine, however, how 
much is accomplished by psychical influence. 



L_ 



LECTTJEE XIV. 

General Prinoiples and Special Teobnioal BecommendatlonB for Eleotrioal Treatment 
—Treatment in Loco Morbi— Technique of the Localization of the Current— 
Local Faradization of the Motor Nerves and the Muscles — Plan of Treatment — 
Personal Acquaintance with the Effects of the Current — Choice of tne Strength 
of the Current — Choice and Management of the Electrodes — Avoidance of un- 
necessary Irritative Effects — Duration and Frequency of the Individual Applica- 
tiona— Entire Duration of Treatment. 

Before I pass to the special part — to the explanation of the electro- 
therapeutic indications and methods of application in the individual forms 
of disease — I desire to present a series of general principles, and also a 
number of special technical recommendations. 

I believe that the most important principle is the treatment in loco 
morbi — i.e., the application of the electricity to the diseased part itself. 
There can be no doubt that, in the overwhelming majority of cases, it is 
best to act directly upon the site of the disease. 

Unfortunately, this rule is limited by the restrictions of our diagnostic 
ability. How often we are in doubt with regard to the accurate localiza- 
tion of nervous disorders every experienced neuro-pathologist knows. In 
cases of diagnostic uncertainty with regard to localization nothing remains 
but the systematic successive application of the .current to the various 
possible localizations ; in these attempts it is well to advance from the 
periphery toward the central organ. 

There is an apparent exception to this principle in the attempt to influ- 
ence certain affections in an indirect way ; for example, by employing 
reflex paths, by indirect catalysis, by so-called galvanization of the sympa- 
thetic. In these instances, however, we also endeavor to reach the site of 
the disease, although in a roundabout manner. 

In certain cases of more diffuse or general neuroses, of constitutional 
or similar diseases, local electrical treatment naturally must be discarded ; 
we then resort to general faradization and galvanization, etc., which have 
been previously described. 

The necessary consequence of the principle just enunciated is the fur- 
therance of the most accurate technique in the localization of the current 

For this purpose you need, above all, a knowledge of physics, espe- 
cially a practical acquaintance with Ohm's laws. You must clearly under- 
stand where and how the electrodes must be applied, how large they 



122 ELECTRO-THEBAPEUTICB. 

must be, the strength of current to be employed, in order to \aing r defi- 
nite part of the body under the desired infiuence of the current. 

In addition, you must possess accurate anatomical knowledge with 
regard to the position of the individual parts, especially of the nervous 
system, and the relation of the deeper parts to the surface of the body. 

I will present to you a short schematic sketch of " local fnradization " 
of the motor nerves and the muscles, explained by a few illustrations and 
short practical remarks. 



TMangnlar 



On the head (vide Fig. 28) the distribution of the facial nerve u the 
most important, and this nerve is also very readily stimulated. The illus- 
tration gives an approximate idea of the BiCUation of the focial branches : 
the darker points indicate the chief positioDs of stimulation. In careful 
investigations the trunk of the nerve should first be aoupht ; this is best 
done with a fine electrode, which is firmly pressed immediately below 
the external auditory canal, fiom behind and outward anteriorly and 
inwardly and upward against the edge of the lower jaw. It may also be 
reached in the estemal auditory- canal, a fine electrode being pressed 
inward, downward, and forward from without and above. 



OEKBRAX BLEOTRO-THBRAPEUnOS. 133 

For accurate comparative examisations I divide the nerve into three 
main branches, and examine these in two positions, immediately in front 
of the ear and also about the middle of their c;>urse. The upper branch 
is distributed to the muBcles above the palpebral fissure ; the middle 
branch to the muBcles in front of the upper jaw, between the palpebral 
and oral fissures ; the lower branch to the muscles upon the lower jaw. 
The points of irritation for examin&tiou in front of the e&r are found upon 
the malar bone, immediately below it, and finally at the edge of the 
SHcending ramus of the jaw {vide the figure). 



niuiffiiliir 



The points of irritation in the middle of the course of the nerves are 
three in number : at the temple, at the anterior angle of the malar bon« 
upon its lower border, and finally in the middle of the lower border of the 
hoiizontal ramus of the jaw. 

The situation of the motor points of the muscles is evident from the 
figure ; they must be determined with very fine electrodes, lightly applied, 
with the weakest possible current. 

The ocular muscles are not accessible to electrical irritation. 

The muscles of mastication are accessible only upon direct stimtdatira 
with a vigorous current in the positions given upon the figure. 



1 24 ELECTRO-THERAPEUTICS. 

The occipital and posterior auricular muscles can be readily stimo^ 
lated upon the mastoid process by the posterior auricular nerve. 

The hypoglossal nerve lyay be stimulated in many persons by a vigorous 
current apphed immediately behind and above the hyoid bone, a fine 
electrode being used and pressed in deeply ; its eflfect is contraction, distor- 
tion, etc., of the corresponding half of the tongue. Dii'ect stimulation of 
the tongue, velum palati and upper muscles of the pharynx can be readily 
performed with a suitable electrode. 

The spinal accessory nerve is stimulated with facility in a great part 
of its course ; the large dot in the middle indicates approximately its 
most irritable part The stern o-mastoid and trapezius muscles are readily 
stimulated separately. 

Numerous nerve-trunks and motor-points are situated in close prox- 
imity in the supraclavicular fossa, viz., the brachial plexus wdth cdl its 
branches and the 2)hrenic nerve. The latter can with difficulty be stimu- 
lated separately ; this must be done with a fine electrode, in order to 
avoid the adjacent nerve-trunka The nerve is situated quite superficially 
at the posterior border of the stemomastoid ; the eflfect of its initation is 
a sudden inspiratery movement, protrusion of the epigastrium, asso- 
ciated with an inspiratery larjTigeal murmur. The eflfect is most marked 
upon bilateral initation with a branched electrode. Artificial respiration 
in asphyxia by means of rhythmical faradization of the phrenic nerves 
is best eflfected by bilateral irritation with broad, flat sponge-electrode 
(Ca) (the An being placed upon the sternum or epigastrium), partly" to 
make sure of reaching the phrenics, partly to stimidate also the branches 
of the brachial plexus and thus cause the auxiliary muscles of respira- 
tion to be brought into action ; the head, shouldei*s and arms should be 
fixed by assistaits. The vigorous faradic current is closed for one to 
two seconds, then opened for the same length of time, expiration being 
aided at the same time by means of vigorous pressure upon the ab- 
domen. 

With some care the individual branches of the brachial plexus are 
readily stimulated separately, especially in lean individuals ; the upper ex- 
tremity may be partly elevated and the head turned slightly toward the 
other side. The axillary nerve (contraction of the deltoid) can be found 
in the upper pai-t, the posterior thoracic nerve (contraction of the rhom- 
boids, ete. ) somewhat more posteriorly, the long thoracic nerve (the ser- 
ratus magnus muscle) more inferiorly and externally. The anterior 
thoracic nerve is found immediately above and below the clavicle and 
somewhat internally. Finally, from a circumscribed point, about two to 
three centimetres above the clavicle, somewhat outside of the posterior 
border of the stemomastoid and immediately in front of the transverse 
process of the sixth cervical vertebra, simultaneous contraction may be 
produced in the deltoid, biceps, brachialis anticus, and supinator longus 
muscles (supraclavicular point). 

In the arm (Fig. 30) the median and ulnar nerves are stimulated with 
readiness in their entire course along the internal bicipital sulcus ; the 
most irritable point of the ulnar nerve is a little above the inner condyle, 
of the median nerve at the elbow. The best position for the stimulation 
of these nerves is slight flexion as in the illustration, with relaxation of all 
the muscles. The effects of ulnar stimulation are : ulnar flexion and ad- 
duction of the hand, flexion of the last three fingers, adduction of the 
thumb. The effects of stimulation of the median nerve are : marked pro< 



GENERAL KLEOTEO-THEBAPBDTICS. 125 

natioD of tbe forearm, flexion of the wriBt, cloaure of the hand, contractioo 
of the thenar muBclee. 

The maaoiilo-cutaneous nerve is readily reached, with a fine electrod«y 



(diJ3 



hetween the coraco-hrachialis and biceps muscles. In the forearm the 
two main nerre-tninks are readily found above the wrist ; the most irri- 
table points are indicat«d on Fi^. 30. The motor points of the n 
are also indicated in the illustration and are readily detected. 



136 SLBOTBO-THBEAPSUTIOS. 

Upon the ezteosor aspect of the upper extremity the radial Berre ia 
the most important and quite difficult to stimulate ; it should be loc^«d 
tax about the middle of a line connecting the insertion of the deltoid and 
the external condyle ; a fine electrode ie pressed deep between the triceps 
and brachialis anticus against the bone and only a small spot is found 
here which is readily irritated. The effect of this stimulation is marked 



Tll0i|H (kiii( had) 



AbducL loDi 
Bit. bnrl 



Snplnit. bmli 
Kit mSn. dliW 



SiL long, pollldi 



AbdDet mln. dlgttl 
J>arml tetiiuwil (in. 



extension of the wrist, extension of the first phalanges, separation of the 
fingers, abduction of the thumb. 

Apart from this, only muscular points are found upon the extensor as- 
pect of the arm and these are indicated on the figure. Upon the trunk 
the musclee cam only be stimulated by direct irritation of the individual 



GENERAL BLBCTBO-THERAPEUTICS. 



12T 



The anterior aspect of the thigh presents simple relations (Fig. 32). 
The crural nerve is immediately adjacent to and somewhat outside of the 
Tessela of the thigh ; it is well to press the electrode toward the pelvis and 
employ a strong current. The effect is contraction of the quadriceps 
and ss^rtorius and extension of the leg. The obturator nerve is reached 
by pressing upon the point indicated in the figure, deeply between the 
muscles and toward the pelvi& The individual muscles can generally be 
stimulated quite readily. 

Upon the posterior aspect of the thigh (Fig. 33) the glutseus maximus 
can be made to contract by direct stimulation alone. The trunk of the 



ObUmtor Dcrrv 
Pootlnrai 

▲ddnotor nuigniu 

Addnotor Vw» p^ff 



Onmlmiuole 



TMtu Infiamasf 




} 



Tenaor iMote late 



fltftoriiu 

QoAdrioefM famotto 
(oonunon point) 



-^ Beotoi feoMrii 



j VmUu cKt^rnw 



Fio. 81 



sciatic nerve is best stimulated at the lower border of the glutasus, the 
electrode being pressed in firmly with a very strong current In the pop- 
liteal space its terminal branches are easily reached. The tibial nerve is 
exactly in the middle, its most irritable point being in the principal trans- 
verse fold. Effect of its stimulation : contraction of the calf, strong plantar 
flexion of the foot, flexion of the toes. The peroneal nerve is more to the 
outside, its most irritable point being in the same transverse fold. Effect : 
strong dorsal flexion of the foot, more or less marked abduction or adduc- 
tion, extension of the toes. 

The muscles of the posterior aspect of the thigh are stimulated with 
difficulty ; it is advisable to keep the leg passively flexed during the ap- 



128 



BLECTRO-THERAPEUnOS. 



plication ; contraction may be produced most readily in the neighborhood 
of the points shown on the figure. 

In the leg we can, in the main, merely stimulate the muscles directly 
from the motor points ; in the thigh the motor points of the gastrocne- 
mius and soleus can be found readily, the latter being irritable only at 
its edges in various places. Lower and to the inside is found the motor 
point of the flexor digitorum commun longus, to the outside that of the 



BetttUcntrv^ 

Bio^M (long baad) 
BlociNi (ihort heftd) 



Ptronealnen4 
Chuiteoon«mlas (outer head) 



Soleiui 



ItaK. halhud t long. 




Glttteos nuudmoi 



Addoctor meginis 

SemitendinoeoB 

SeooixnembniMMaf 



« TIMoffMrve 



Qaiteocneinipt (inner he>i) 



Qoletu 



Flex, digit oomm. loogoi 



TWai 



Fio. 88. 



flexor hallucis longus ; still lower, to the inside of the tendo AchiUis, the 
tibial nerve, from which a contraction of all the plantar muscles may be 
secured. On the anterior aspect of the leg the trunk of the peroneal 
nerve can be stimulated above at the head of the fibula. 

The motor points of the tibialis anticus, extensor digitorum longus, and 
peroneus longus are situated at about the same height and require toler- 
ably strong currents ; farther down to the outside is the motor point of 
the peroneus brevis, still lower, near the edge of the tibia, that of the ex- 



OENBBAL ELBOTBOTHEBAPBUnOS. 



129 



tenaor haHncis longas. Upon the dorsum of the foot, the extensor 
tornm brevis^ abductor minimi digiti, and dorsBl interossei are readily 
stimulated. 

The localization of the current in other parts of the body can be readily 
determined by a careful consideration of the anatomical relations. THth 
regard to the skull it is important to know accurately the projection of the 
individual parte of the brain upon the surface. Thus, for example, the 




ImIIboIi loBSi 



mhLdigitt 



Fio. 84. 

region of the third frontal conyolution (speech centre) is somewhat in 
front of and above the ear {vide Figa 28 and 29) ; the region of the oen- 
tral convolutions extends from this part backward to the vertex ; the 
medulla oblongata lies between the mastoid processes and the two auriculo- 
mastoid fossae ; the large basal ganglia are situated between the temples, 
etc. I have previously described the position of the superior cervical gan- 
glion in the neck ; the lower one may be sought with a broad electrode next 
to the stemo-mastoid above the clavicle, the other electrode being placed 
iq>on the dorsal spine. 

In every individual case which comes under your care, you should first 
9 



180 ELEOTEO-THEBAPKUnca 

form a definite plan of treatment This method should be pursued for 
some time, and if its inefficiency is then distinctly shown you may adopt 
another plan. 

I consider an accurate personal knowledge of the efiects and strengths 
of the currents as indispensable for every practical electro-therapeutist. 
Make frequent experiments upon your own body, determine the law of 
contraction of your various nerves, faradize all the nerves and muscles of 
your body which can be reached, determine the sensations produced by 
various strengths of current upon different parts of the body, etc ! In 
this manner you veill learn how to produce any desired action with the 
least possible irritant efifect. 

It is advisable not to begin with too strong currenta The strength of 
the current should be first tested upon your own face or hand. If you at 
once attack a patient with a very strong current you may frighten him 
and destroy Ms confideDce. The best means of possessing constant con- 
trol over the strength of the current is imdoubtedly the presence of a 
galvanometer in the circuit of closure. The strength of the current may 
also be gauged approximately by the intensity of the sensation of burning 
of the skin produced by application of the electrodea 

It is especially important to employ only mild currents upon the head 
(with the exception of certain cases of aural disease). Sudden interrup- 
tions or reversal of the current should be avoided in this locality, unless 
rendered necessary for special reasons. 

Li the employment of the galvanic current use the largest possible 
electrodes (unless some special purpose necessitates small ones) permitted 
by the anatomical relations of the parts and their applicability. They 
should be kept thoroughly moistened by dipping them in hot water. Ap- 
ply the electrodes firmly to the parts, especially when operating with 
strong currents. There is nothing more disagreeable to the patient than 
the sudden and repeated electrical shocks which occur when the electrodes 
are applied unsteadily. 

Avoid all unnecessary irritation ; do not make any interruptions or 
changes of polarity, if not required. This rule is to be especially ob- 
served in the treatment of the central nervous system, the production of 
certain catalytic effects, in neuralgias, etc. 

The duration of the individual applications and sittings is a not unim- 
portant question. Almost all the later electro-therapeutists are agreed 
that short sittings are as effective as long ones, if not more so. There are 
naturally not a few exceptions, as in the local treatment of chronic articu- 
lar rheumatism, in the production of energetic catalytic effects, in general 
electrization and the like. 

In ordinary cases, each individual application, i.e., to a certain part, 
should last from one-half to two, at the most eight minutes, and the entire 
ffitting from two to ten, at the outside fifteen minutea 



GBNBSAL ELEOTBO-THERAPEUTIO& 181 

No general roles can be laid down with regard to the freqaenoy of the 
repetition of the sitting& One sitting daily is preferable as a role, and a 
la^er number are rarely necessary. In many oases which ran a chronic 
course two to four sittings a week wiU suffice. 

Very little can be said with regard to the duration of treatment ; in 
chronic cases it is best to continue treatment so long as good results are 
visible or may be expected. If this is not the case, the treatment should 
be interrupted, but repeated, as a rule, after a certain lapse of time. You 
will not ioirequently observe a more rapid and vigorous action after such 
intermissions. 

In general it may be said that such chronic cases should be treated from 
two to six months, then an interval of equal length allowed to elapse, which 
may be filled in serviceably by other methods of treatment (baths, climatic 
cures» massage, etc.), or two to three series of forty to sixty sittings (daily 
or every other day) are held every year. In this manner obstinate cases 
of infuntile spinal paralysis, tabes, chronic myelitis, spastic spinal paralysis, 
old hemiplegia, hysteria, neurasthenia, etc., may be treated with advan- 
tage for a number of years. Of course this will depend more upon exter- 
nal circumstances, the pecuniary condition of the patient^ and the like, than 
upon the character and course of the disease. 



ELEOTRO-THERAPEUTIOa 



SPECIAL PABT. 



PART V. 



SPECIAL ELECTRO-THERAPEUTICS, 



INTRODUCTION. 



We now come to the consideration of the action of electridtj in 
indiYidnal forms of disease, the indications for the use of this remedy, 
and of the methods suitable in various diseases— i.6., to special electro- 
therapeutics. 

In my preyious lectures I explained that we had determined not a few 
points of departure from which we might expect various and even mani- 
fold curative effects from the use of electricity ; but I was compelled to 
add that we are still restricted more or less to an empirical standpoint — 
that electro-therapeutics is still founded mainly on experience. 

We must therefore carefully examine electro-therapeutical experiences, 
in order to determine whether they justify the assumption of curative ef* 
fects ; whether they can be subjected successfully to the inductive method 
of investigation, and can therefore be employed as the basis for the deter- 
mination of therapeutic indications. 

This means nothing more nor less than a critical sifting of my personal 
experiences, as well as of those accumulated in literature — a task which 
can with difficulty be carried out Apart from the prejudices which most 
specialists entertain in favor of their own methods, of the more or less 
unintentional self-deceptions to which they are liable, we have to deal in 
these cases with forms of disease in which even the most conscientious and 
skeptical observer may fall a victim to the grossest error. In nervous dis- 
eases, especially in the numerous functional neuroses, remarkable improve- 
ment and recovery occur, apparently spontaneously, with such frequency, 
the psychical element and many other factors play such a great part, that 
the '* post hoc ego propter hoc " very often leads to false conclusions. In 
other cases, again, we have to deal with such tedious, morbid processes, 
that the possibility of spontaneous remissions and improvement will readily 
doud our judgment with regard to the therapeutic result Or other 



1 36 ELKCTRO-THEBAPEUTICS. 

simultaneous effects cannot be excluded ; the &Torable results of other 
methods of treatment or after-effects of other cures (baths, eta) may be 
falsely attributed to electricity. 

lly in the face of such difficulties, the man of large experience does not 
entirely lose the hope of '* rising from this sea of error," this is due to the 
fact that so much that is hopeful and stimulating is manifested in a varied 
experience, so much proof of the benign effects of electricity, that a neyer- 
ceasing stimulus to further labor and investigation in this difficult field is 
developed. 

But for scientific demonstration, for the gradual formation of the foun- 
dations of scientific electro^therapeutics, an extremely careful selection of 
cases must be made. Those alone may be chosen which are based on cer- 
tain and accurate observation, and in which, from the rapidity and magni- 
tude of the results, from the exclusive application of electricity, and all 
the attendant circumstances, it is rendered as undoubted as possible that 
the therapeutic result is due solely to electricity and not to chance or 
other circtmistances. 

A second important object is the determination of the methods accord- 
ing to which the electrical treatment may be best carried out in individual 
cases. As you have learned, this cannot be done a priori upon the basis 
of our knowledge of the various physiological actions of the current, 
although these must serve as guides in our investigations, but is only pos- 
sible upon the basis of a large and critically sifted experience. There can 
be no doubt that exact and scientific methods alone will lead to the goal 
Above all, they must be based upon clear physical conceptions ; then they 
may be guided by our physiological knowledge of the most important 
actions of the current Experience, however, must constitute the final and 
decisive criterion. 



L DISEASES OF THE BRAIN, INCLUDING THE 

PSYCHOSES. 



LECTURE XV. 

Introdnotozy BemarkB—Physiological, Ezperimental, and Theoretioal Basis of Elactro- 
therapentios of the Brain— Therapeutical Facto— Collection of a Series of Indi- 
Tidaal Observations — Conolosions therefrom—Negative or Partial Curative Effects 
— The Forms of Disease in which Electro-therapeutic Suooess may, and those in 
which it may not, be expeoted. 

Fob a long time certain prejudices preyented the direct application of 
electrical currents to the skull in various cerebral diseases. The occasional 
reports of the favorable therapeutic efifects of such a procedure were 
received with decided mistrust It was maintained by eminent authorities 
that the current could not be conveyed through the bones of the skull 
into the brain ; while, on the other hand, others described in lively colors 
the dangers of such an application to the head, especially of the galvanic 
current After my investigations had shown that the brain could be 
readily reached, even by mild faradic and galvanic currents, it was also 
gradually discovered that the application of electrical currents to the skull 
does not present any special dangers. Nimierous experiments upon the 
healthy and sick, especiaUy the often-practised examination and treatment 
of the auditory apparatus with very strong galvanic currents, have long 
since proved the contrary. The application of electrical currents to the 
head is very well tolerated, without exception, by healthy individuals ; a 
certain amount of caution is necessary when the brain is diseased, but the 
stories of serious disturbances of the brain, apoplexy, amaurosis, etc., in 
consequence of faradization or galvanization of the head, have received no 
authentic corroboration. 

The attempt could therefore be made, with a certain amount of con- 
fidence, to make cerebral diseases the subject of electrical treatment ; but 
the question first arose whether any justification existed for attempting to 
treat diseases of the brain by the application of the electrical current and 
for expecting definite curative effects therefrom. 

A more careful consideration shows, indeed, that various data are fur* 



138 ELECTBO-THEBAPEUnOS. 

nished which, in a series of cases, lead to the hope of a favorable inflaenoe 
of electricity upon the diseased brain. 

The simple fact that electrical currents really act upon the brain, that 
they produce vertigo, a feeling of dulness and nausea, that they act favor- 
ably upon sleep, etc., is indeed a very meagre foundation for therapeutical 
application. But at all events, we may therefore conclude that stimulating 
and modifying effects upon the cerebral substance are possible, that per- 
haps changes may be produced in the molecular or finer nutritive relations 
of the organ, and the outlook is thus presented of securing a favorable in- 
fluence in morbid functional disturbances of the brain, in conditions of 
exhaustion, and perhaps in morbid irritations, sleeplessness, etc. 

More important data are furnished by the previously mentioned state- 
ments with regard to electro-physiological action upon the cerebral vessels, 
the most important being their direct change (contraction and dilatation), 
as was experimentaUy proven by Loewenfeld. This at least opens up a 
more distinct possibility of accelerating or retarding the circulation in the 
skull and brain by means of electrical currents, of modifying the nutritive 
conditions, perhaps producing an alterative action upon pathological pro- 
cesses, of antagonizing hypersemias and aneemias (primary as well as second- 
ary) with their sequences. According to Loewenfeld*s experiments, this 
would be possible in a direct manner ; the physiological foimdation for the 
indirect vasomotor influence of the cervical sympathetic and spinal cord 
upon the brain is less positively established. 

Very few data are as yet available with regard to a more remote, indi- 
rect influence upon the cerebral circulation by means of reflexes from the 
integument; but the recent experiments of Bumpf and the therapeutic 
experiences reported by him, at least open up the possibility of securing 
favorable results in this manner ; perhaps many favorable efifects of pe- 
ripheral electrical treatment upon cerebral affections can be explained in 
this way. 

Even more obscure are the probably molecular, dynamical effects upon 
various cerebral functions from stimulation of sensory nerves. I do not 
now refer to the metalloscopic experiments, but to those of Vulpian, who, 
by means of local, circumscribed faradization of certain portions of the 
integument of the forearm, caused the disappearance of cerebral hemian- 
cesthesias, which were probably produced in part by anatomical changes 
in the bndn. 

Much greater hopes are aroused by the catalytic effects of electrical 
currents, though these have only been determined with certainty in other 
parts of the body. The possibility of a direct action upon the brain and 
its parts being taken for granted, we are justified in assuming that these 
effects will not fail us in certain morbid processes within this organ, and 
it is therefore very probable that by means of electrical currents we can 
facilitate the absorption of hemorrhagic extravasations, relieve oedema and 



SPECIAL ELECTRO-THSBAPSUTIC& 139 

oollaieral fluxions, improye the nutrition of parts, relieve, or at least mod- 
erate, chronic inflammatory, sclerotic, degenerative, and similar conditions. 
I will now give a selected number of observations of this character : 

1. ObsenxUion by Neftel, Cerebral neuradhenia. — A busy physician, 
aged forty-two, sick in consequence of over-work ; suffers from loss of 
physical and mental energy. Ability to work greatly diminished ; suffers 
from insomnia, a dull feeUng in the head ; melancholic depression ; loss 
of desire and inability to work or read ; readily gets tired ; general weak- 
ness, feeling of heaviness in the back. Examination gave negative results, 
with the exception of some albumen in the urine without any morpho- 
logical constituents. Oalvanic treatment : Ca on the back of the neck, An 
stabile and slowly labile over the eyelids, forehead, temples, and auriculo- 
maxillary fosssB on both sides ; then the same procedure |(rith reversed 
position of the electrodes, and finally galvanization of the cervical sympa- 
thetic. Great relief after the first sitting, better sleep ; progressive im- 
provement, finally recovery ; the albumen disappeared. 

2. Personal observation. Emotional neurosis ; hemiparesis of the right 
side. — ^A merchant, aged forty-six, had a severe emotional disturbance (in 
consequence of being insulted) ten weeks before ; immediately afterward 
suffered from epigastric pressure, nausea, loss of appetite ; then vertigo, 
staggering walk ; later, gradually increasing weakness and tremor of the 
right hand, so that he could no longer vrrite ; then a general feeling of 
weakness and being tired. Tendency to cry, depression, restlessness ; often 
has poor sleep. Memory is impaired, his thoughts often fail him in speak- 
ing. Examination shows slight paresis of the right facial nerve. The tongue, 
psJate, mastication, and deglutition normal, also movements of the eyes and 
pupils. The right arm is decidedly weaker than the left ; marked tremor 
in stretching out the hand, the movements of which are somewhat awk- 
ward and weak (dynamometer, right hand 26*^ ; left hand 51°). Sensibility 
of the right upper extremity normal, the tendon reflexes somewhat in- 
creased. Motion and sensation of the right lower extremity normal ; the 
tendon and plantar reflexes slightly increased. Galvanic treatment ; 6 
elements Stoehrer from the neck to the forehead ; 8 elements to the cer- 
vical sympathetic ; 18 elements Ca labile through the nerves and muscles 
of the rignt arm ; daily sittings. 

June 26, 1879. — ^Before the first sitting, dynamometer, right 26°, left 
61° ; after the first sitting, dynamometer, right 39°, left 44°. Better gen- 
eral condition and sleep afterward. 

June 29th. — Changeable condition ; improvement on the whole. Be- 
fore the galvanic treatment, dynamometer, right 32°, left 43° ; after the 
galvanic Ireatment, dynamometer, right 42°, left 41°. 

July 6th, — Headache, vertigo, sleep improved. Before the galvanic 
treatment, dynamometer, right 40^, left 41° ; after the galvanic treatment, 
dynamometer, right 40°, left 43°. 

July 12th. — Patient feels decidedly better with regard to the head and 
speech ; sleeps much better. Still complains of pain in the arm, which is 
much better, but not perfectly useful ; the sHght difference in the face 
still continuea Stopped treatment. 

3. Personal observation. Insomnia / mental depression, — A widow, aged 
forty-one years, very depressed for about two months in consequence of 
emotional disturbance, with marked prsecordial anxiety and almost com* 



140 ELEGTRO-TH£RAP£UnG& 

Slete insomnia with yery restless thoughts, restlessness of the limbs, etc 
[oderate ansemia. Appetite and digestion good. Chloral and morphia 
are not tolerated. Ordered tea and electrical treatment at night 

January 2l8t. — Faradization of the head with the hand. 

January 22d. — No improvement ; great terror ; faradization of the 
head and also from the neck to the epigastrium. 

January 23d. — Slept one hour and a half ; terror much diminished. 

January 24th. — Has not slept (on account of abdominal pain and 
diarrhoea). 

January 26th. — Slept two hours ; abdomen normal 

January 26th. — Has not slept (made a visit in the afternoon). 

January 27th: — Has not slept ; terror has disappeared. Gkdvanic treat- 
ment now begun : 4 elements, Stoehrer, from the forehead (An) to the 
back of the neck, stabile, for a minute and a half ; 6 elements from the 
neck to the epigastrium, stabile, for a minute and a half. 

January 24th. — Two hours sleep : terror has permanently disappeared. 

January 29th. — ^Two hours and a half sleep ; similar treatment. 

January dOth and 31st — Has not slept (menses about to begin !) bat 
disposition good. 

February Ist — Three hours sleep. 

February 2d. — Slept more than five hours ; feels welL Beginning <^ 
the menses, during which she did not sleep for two nights ; migraine ; 
alight feeling of terror. No galvanic treatment 

February 5th. — Slept the whole night (seven to eight hours) ; has not 
had such a good night in montha Q^vanic treatnfent 

February 6th. — Five to six hours sleep. Terror entirely disappeared. 

February 7th. — Seven and a half hours sleep without interruption. 
No headache or terror ; feels perfectly welL Leaves to-day. A later 
communication shows that the improvement has continued ; sleeps four to 
five hours every night 

4. Observation by Eumpf, Hypercemia of the brain (?) {cerebral neuras- 
thenia), — ^A merchant, aged forty-seven years. No neuropathic tendency, 
formerly always healthy. In consequence of great exertion and excite- 
ment, first had impleasant sense of pressure in the head, then readily 
flushing of the face and a feeling of congestion of the head. Increasing 
heaviness and dulness of the head, occasionally severe headache ; annoy- 
ing sensation of vertigo, especially in raising and lowering the head ; ring- 
ing in the ears ; diminished capacity for work ; condition of excitement, 
even upon slight cause ; very poor sleep. Spinal functions normal Ob- 
jectively everything normal. Bromide of potassium unsuccessful. Treat- 
ment : vigorous faradio brush over the back, chest, and upper extremities ; 
this was followed by desire to sleep, head clearer. All symptoms disap- 
peared after a second application. 

6. Personal observation. Bight hemiplegia (from cerebral hemorrhage f). — 
A carpenter, aged twenty-five years. February 10, 1872 (at a ball), sudden 
occurrence of hemiplegia, without loss of consciousness and aphasia, but 
with indistinct speech (anarthria). Complete paralysis of the right side, 
also the face ; formication, but sensation retained. Gradual improve- 
ment up to present time ; condition entirely healthy heretofore. Condition 
on April 8, 1872 : right hemiplegia, paresis of the lower branches of the 
facial nerve, the tongue deflected readily to the right ; uvula straight, 
velum palati normal. Forearm slightly movable, hand and fingers not al 
all ; slight mobility at the shoulder-joint. Slight contracture of the 



SPECIAL ELEOTBO-THEBAPEUnCS. 141 

flexors of the arm. Lower extremity paretic and 8ti£^ but patient can 
walk aroand. Sensibility normal ; some feeling of numbness in the tipe 
of the fingers. Pupils and ocular movements normal No aphasia. He^ 
entirely normal 

Gkdvanio treatment : Longitudinally through the left half of the skull, 
stabile, and transversely from the left forehead to the right brachial 
plexus ; then the Ca labile through the nerves of the right arm. On the 
following day the patient states there is distinct improvement. Careful 
observation (April 9th) shows, before the galvanic treatment, absolute 
immobility of the fingers ; the hand can only be raised to withhi an inch 
and a half of the nose and the hair on the templea After the treatment 
(of the head alone), patient raises the hand readily to the nose, can flex 
the fingers slightly, the movements of the forearm are somewhat freer. 

April 11th. — ^After each sitting the patient notices considerable improve* 
ment, and also in the leg, which has hitherto not been examined or ti^ated. 

April 15th. — Continued improvement ; the movements of the arm are 
freer, flexion of the fingers is possible to a slight degree ; the patient 
readily grasps the head and nose ; the leg especially (which was never 
treated) is more vigorous after each sitting. 

August 1, 1872. — The patient is discharged to-day veiy much im- 
proved. Walks freely and easily ; mobility of the arm much better ; also 
quite good in the extensors ; no more contracture. Writing still impos- 
sible on account of deficient pronation. Since thie end of September, the 
patient works a little at his trade. 

6. Obseroation by Brenner, Cerebral hemiplegia; sudden considerable 
improvement of the paralysis, — A merchant, aged thirty-eight years ; acquired 
syphilis in 1863 ; repeated relapses, irregular treatment At the end of & 
year and a half the patient awoke one morning with complete right hemi- 
plegia, distortion of the face and disturbance of speech. At the end of 
four weeks, complete paralysis of the right upper and lower limbs, with 
very moderate contracture of the flexors ; paresis of the lower part of the 
face, without ansdsthesia. After the muscles of the arm had been stimu- 
lated about half a minute, the patient suddenly became able to move the 
arm, to lift it from the trunk and flex the forearm. The efifect upon the 
leg was even more striking ; after a few contractions through the crural 
and peroneal nerves had been secured, the patient arose and walked 
through the room without support, though the foot dragged. In the 
further course of treatment the paralysis improved somewhat, though not 
much, and permanent hemiparesis with contracture remained. 

7. Personal observation. Eight hemiplegia; sudden improvement, — 
An officer, aged fifty-three years ; suddenly paralyzed three years ago 
vnthout loss of consciousness. At first complete paralysis. The face is 
now well, the leg still weak, the patient only able to walk with a cane ; 
arm almost completely paralyzed, with marked flexor contracture. Elec- 
trical excitability norniaL Immediately after faradization of the nerves 
and muscles of the arm, the patient can move the fingers somewhat 
better ; likewise during the passage of a galvanic current transversely or 
longitudinally through the head. After this first (explorative) sitting, de- 
cided improvement had occurred ; the patient feels freer and stronger, 
rising from a chair is effected more readily ; he walks without a cane. 
The arm is not improved. Prolonged electrical treatment did not add 
much to the improvement thus effected at the outset 

8. Observation by Nefiel. Right hemiplegia and c^hasia (from embot 



142 ELECTBO-THBRAPEUnCS. 

ismf), — ^A man, aged thirty-eight years. February 23, 1877, a serere 
apoplectic attack, followed by right nemiplegia and aphasia. Bapid im- 
provement ; persistent paresis of the lower limb, still more of the upper 
limb. Right-sided disturbance of sight and hearing ; headache, melan* 
cholic depression ; general weakness, sleeplessness ; systolic murmurs at 
the npex of the heart Paresis of the rectus intemus of the right eye ; 
nasal hemiopia of the right eye. Ghtlvanic treatment (beginning March 
19, 1877) : 1. Ca in the necJc, An stabile and slowly labile upon the eye- 
lids, forehead, temples and both aiuiculo-maxillary fossse (4 to 7 Sie- 
mens' elements). 2. The same procediire with reversed electrodeB. 
3. Galvanization of the cervical sympathetic (Ca on the ganglion). Im- 
mediate improvement ; head freer, sleep better ; insufficiency of the rectus 
intemus disappears, also the defect in the field of vision ; the paresis of 
the limbs also improves (they were only treated twice, more for diagnostic 
purposes). Interruption of treatment on March 29th (eleven sittings). 
After a few weeks, a relapse, especially headache, vertigo, insomnia, pains 
in the right arm. May 29th renewed treatment (same plan) ; consider- 
able improvement after eight sittings. 

9. Observalion by Morilz Meyer. Hemiplegia^ probably from hemor- 
rhage. — A merchant, aged twenty-six years, feeble, suffering from palpita- 
tion of the heart, and hyi)ertrophy of the left ventricle without valvular 
disease ; vertigo, followed shortly by unconsciousness, convulsions, and 
complete motor and sensory hemiplegia of the left side, paralysis of the 
bladder. Very gradual improvement Two years later : left arm can 
with difficulty be raised to an angle of seventy degrees, is emaciated, 
cold, partly anaesthetic ; moderate flexor colitracture ; head dull ; bladder 
in tolerable condition. Treatment : in the beginning merely galvanization 
of cervical sympathetic (An to the left upper ganglion). Results very 
satisfactory ; after twelve sittings the arm can be raised completely and 
extended, sensibility has improved ; the leg is dragged less ; head freer. 
Descending neuro-muscular current was then employed: after fifteen sittings 
the mobility of the hand and fingers was considerably improved ; tempera- 
ture of the arm approximately normal ; sensibility not completely restored. 

10. Observation by Vulpian. Monoplegia of the right arm wUh complete 
anoesthesia (probably from a hemorrhage). — A laborer, aged eighteen years ; 
apoplectic attack ; unconsciousness ; upon restoration of consciousness, 
the right upper limb was found completely paralyzed ; with the exception 
of a rapidly disappearing aphasia, the pcu:*alysis v^as exclusively confined 
to the right arm ; in addition to the complete paral^'sis, there was also 
complete ansesthesia of the limb. Various methods of treatment (nitrate 
of Sliver, chloride of sodium and gold, faradization and galvanization of 
the paralyzed arm) produced very little improvement in mobility and sen- 
sibility. After the lapse of five months the patient was subjected to cuta- 
neous faradization (active faradic brush to a very limited portion of the 
right forearm). Hapid improvement of motion and sensation occurs. Sen- 
sation improves daily from above downwnrd ; motion in such a manner 
that, at the end of twenty days, the dynamometer shows right 8^, left 57°. 
On one of the following days, dynamometer on the right side, before fara- 
dization 10°, after faradization 17°. At the end of five weeks, sensation is 
restored to the tips of the fingers, all movements of the arm executed 
without any special effort At the end of two months : dynamometer, right 
hand 35°, left hand 60°. The patient uses the right hand as well as the 
left, but the former is a little weaker. 



SPKCIAL ELECTRO-TUEBAPEUnCS. 143 

11. Observation by Althaus, Left hemiplegia {from hemorrhage?), — A 
woman, aged fifty-three years, two months previously had an attack of apo- 
plexy with left hemiplegia. She can now waJk a little, but the arm is entirely 
powerless ; arm and leg warmer than on the right side ; flexor contracture, 
whose passive removal causes great pain. Increased faradic excitability. 
Application of galvanic current to the right temple, the superior sympa- 
thetic ganglion, and from the spine to the nerves of the limbs, with inter- 
ruptions of the current. Noteworthy effect upon the muscular contrac- 
ture ; soon after the sitting the patient can extend the arm and open the 
hand ; the gait is also improved, but the improvement continued only a 
few hours. But after treatment for six weeks (twelve sittings), the patient 
can walk quite well alone, and has recovered the use of the arm in great 
measure ; contracture and pain have disappeai*ed. 

12. Observation by Althaits, Monoplegia of the right arm {from embol- 
ism f), — A merchant, aged fifty-two years, suddenly suffers from a feeling of 
faintness and vertigo, and at once loses completely the use of his right 
arm ; no disturbance of consciousness or speech ; leg and ^e unaffected. 
Two days later complete paralysis of the forearm and hand, and almost 
complete anaesthesia of the hand and fingers. Application of the galvanic 
current for one minute to the left hemisphere ; the patient can then move 
the wrist and the fingers somewhat. Two days later the improvement was 
found to be persistent, but had not progressed ; galvanization of the brain 
again caused slight improvement of the motion of the hand ; the addition 
of peripheral galvanization of the radial and median nerves produced 
further and more marked improvement. A third galvanic sitting secured 
complete recovery. 

13. Observation by Rumpf Right hemiparesis {anatomical diagnosis un- 
certain). — ^A man, aged thirty-six years ; sick for several years ; pains in the 
back, right arm, and hip ; parsesthesia and weakness of the entire right 
side ; inability to work, poor memory, dull feeling in the head, insomnia, 
poor spirits. Objectively patient shows slight paresis of entire right side, 
including lower branches of facial nerve ; slight ataxia of movements on 
right side ; distinct analgesia over entire body ; tendon-reflexes very 
marked on both sides. Upon the left parietal bone is a somewhat deep 
osseous cicatrix, due to previous injury. GhJvanic treatment, continued 
for some time, useless. Treatment with the faradic brush (to the trunk 
and extremities) causes rapid improvement ; the pain and parsesthesia dis- 
appear, sleep improves At the end of six weeks, the only symptoms 
remaining are a slight change in the position of the mouth and slight 
analgesia ; the paresis has disappeared. 

14 Personal observation. Tremor of the head, attacks of vertigo {incipient 
multiple sclerosis f). — A shoemaker, aged forty-one years; previously healthy, 
never syphilitic. In March, 1877, sudden severe attack of vertigo, with 
subjective appearance of fire ; then loss of consciousness for two days ; 
afterward severe headache, pain in the back and legs. On every attempt 
at motion, marked tremor of the head occurs, but disappears during rest. 
During next few months, gradual diminution of the tremor so that the 
patient was again able to work. April, 1878, renewed violent vertigo, 
headache, pain in the legs, sticking pain and ringing in the left ear ; no 
disturbance of consciousness, but return of the tremor in much greater 
severity. Improvement in the hospital ; tolerable condition, also, during 
the following winter. 

End of March, 1879, another attack of vertigo, with severe headache^ 



144 SLEOTBO-THBRAPEUnCS. 

but withont disturbance of consciousness ; pain and a sense of heavineaa 
in the legs ; greatly increased tremor of the head, and now tremor of tbe 
arms ; difficulty of speech ; feebleness of memory ; diminished mental 
ability ; eyesight also said to be enfeebled. Ck>ndition on June 7, 1879 : 
nothing abnormal in quiet position ; on excitement or motion, very actiTe 
tremor and shaking of the head. Eyes normal also ophthalmoscopically. 
Otological examination shows old tubal and middle-ear affection on Uie left 
side. Tongue, gums, mastication, and deglutition normal ; speech some- 
what stuttering and uncertain. No noticeable disorder of the upper limbft, 
except slight unsteadiness of movement and slight twitchings on Uie left 
side ; no distinct tremor and no ataxia. In the lower limbs, more decided 
uncertainty of movements, but no distinct ataxia. Galvanic treatmmit : 
longitudinally and transversely through the head, also to the cervical sym* 
pathetic. 

Jime IGth. — The tremor has diminished perceptibly during the last 
few days ; to-day no trace of former tremulous movements is left Hie 
patient also feels much better subjectively. Headaches have disappeared 
entirely ; occasionally a sense of pressure in the head ; greater mental 
vigor ; sleep improved. 

July 2, 1879. — Discharged as entirely cured. In October, 1879, no 
cerebral symptoms are present, and the tremor has ceased permanently. 

16. ObservoHonbyMoritz Meyer. Left hemiplegia after acute ejtcephaliHs, 
— ^A boy, aged eight years, acquired, in 1865, a complete paralysis- of the left 
half of the body, associated with unconsciousness and violent convulsions. 
May, 1866, improvement in the leg. January, 1867, the arm still entirely 
useless, cold, drawn toward the thorax, moderately contractured. Deltoid 
and radial distribution partially, ulnar distribution completely paralyzed. 
Electro-muscular contractility intact ; sensation not disturbed. T^reatment : 
faradization of the paralyzed muscles ; decided improvement after thirteen 
sittings ; after forty-two sittings, mobility of arm and fingers almost 
normal. 

16. Personal observation. Paralysis of numerotis bulbar nerves. — A 
laborer, aged forty-eight years ; sick since June, 1871, with pains in the 
upper limbs, sti&ess of the lips, violent headache, flashes of light, and occa- 
sional diplopia. Later, pain in neck ; the head feels heavy and sinks forward ; 
increasing difficulty in mastication and deglutition. In the autumn of 1871, 
severe pains in the legs, occasionally wesJLness in the legs and arms ; con- 
stant, severe vertigo ; tinnitus aurium. The speech grew feeble and 
hoarse ; the tongue felt heavy ; flow of saliva ; tendency to ptosis* Sleep 
poor, disturbed by pain and tinnitus aurium. 

January 30, 1872. — Slight impairment of speech ; voice feeble. Pupils 
and ocular movements normal ; no ptosis. Hearing destroyed on left side, 
diminished on right ; constant tinnitus aurium on both side& Muscles 
around mouth stiff and awkward ; inability to whistle. Tongue cannot be 
protruded well ; shows distinct fibrillary contractions. Velum palati and 
uvula look normal, but stimulated with difficulty. Pain in neck and back ; 
no abnormality of position or mobility of head. Deglutition impaired ; 
mastication very much impaired. Sensibility normal throughout Severe 
shooting pains in right arm, the power of which is somewhat diminished ; 
legs readily tired. Galvanic hypercesthesia of both acoustic nerves ; poly- 
pus in left auditory canal. 

Galvanic treatment, 8 elements, Stoehrer, transversely through the 
temples and mastoid processes ; 10 to 12 elements to the cervical 



SPECIAL ELBOTRO-THEBAPEUnOS. 149 

fljmpathetic. An stabile upon each ear, the current being graduallj ia* 
creased and diminished. Considerable improvement in a few days. 

February 3d. — Slight headache ; legs stronger ; tongue protruded bet- 
ter ; patient can again whistle ; deglutition and mastication decidedly 
better. 

February 12th. — CJontinued improyement ; head stills feels a little dull ; 
limbs almost free from pain ; deglutition, mastication, and whistling nor- 
mal ; tongue protruded with r^uliness. The further course favorable, 
with slight interruptious. 

March 27th. — Patient discharged cured, with exception of aural symp- 
toms (after fifty-two sittings). 

17. Personal observation. Bulbar aymptomrcomplex {Erb). — ^A man, aged 
fifty-six years ; taken sick in February, 1868, with shooting pains in neck, 
slight headache ; afterward weakness of neck muscles, so that the head 
could no longer be held erect In the beginning of Jime, increasing 
paresis of muscles of mastication and weakness of upper eyelids ; finally, 
some difficulty in the movements of the tongue and interference with deg- 
lutition; otherwise normal. End of June, 1878, peculiar position of 
head from paresis of neck muscles ; bilateral ptosis ; marked weakness of 
muscles of mastication, the mouth usually kept open. Mobility of tongue 
not noticeably disturbed ; it presents fibrillary contractions. Atrophy of 
the muscles of the neck. Limbs normal Oalvanic hypersBsthesia of tiM 
left acoustic nerve. 

Qalvanic treatment, 10 elements, Stoehrer, transversely through the 
mastoid processes, stabile, and also to the cervical sympathetic ; Ca labile 
through the spinal accessory nerves and the neck muscles ; slow improve- 
ment. After sixty sittings, the patient is decidedly better ; can hold the 
head better, deglutition normal, mastication much improved. Discharged 
from September 7th. 

October 30th. — Iodide of potassium administered. Distinct improve- 
ment upon readmission ; position of the head markedly better ; ptosis 
slighter ; mastication and deglutition normal, month no longer kept open. 
After twenty-three sittings more, patient was discharged December 7, 
1868, as almost cured. 

The cases reported above prove beyond a doubt that electrical currents 
may produce recovery in various cerebral diseases, even in cases in which 
other remedies have been employed for a longer or shorter period and have 
proved more or less useless ; that, indeed, our a priori expectations have 
been realized in a series of cases. 

But you must not expect that this wiU occur with any regularity ; it 
cannot be denied that these scanty positive successes are opposed to a 
much larger number of cases in which negative results were obtained. 

There is also an entire series of cases which cannot be regarded as 
strict proof of the curative effects of electricity, because the improvement 
occurs very slowly and gradually, not infrequently other remedies being 
also administered. Here the favorable e£fect of electricity is not excluded 
but cannot be strictly proven. 

Not infrequently cases occur (as in Observations 6 and 7) in which 
a very rapid and striking improvement develops forthwith after the em* 



146 ELECTRO-THERAPEUTICS. 



\ 



plojment of electricity, but only progresses to a certain extent^ then 
comes to a stand-still and cannot be furthered by continued treatment 
Thus we find, for example in somewhat chronic apoplectic paralysis, a 
striking improvement in mobility occurs almost suddenly. After one or 
two sittings, movements return which seem to have disappeared entirely, 
the patients can suddenly walk better, use the hand better, and hope for 
<x>mplete recovery. But this hope is deceptive. After a short time a 
stand-still occurs^ and the subsequent improvement is very slight We 
may also find that the sensory disorders, paraesthesia?, disturbances of 
special senses, aphasia, anarthria, etc., which are associated with the 
hemiplegia, very rapidly disappear, while motion does not improve to an 
equal degree. In such cases we remove only the secondary disturbances, 
caused by pressure upon the vicinage of an apoplectic focus, by circula- 
tory disturbances, oedema, inflammatory conditions, etc.; perhaps, also, a 
certain part is played by secondary peripheral nutritive disturbances in 
the nerves and muscles. We may expect curative results from electrical 
treatment, vnth more or less certainty, in the following cases and cate- 
gories of cerebral disease : 

Especially in so-called fimctional disorders of the brain, in various 
cerebral neuroses, of whose anatomical origin we are as yet ignorant 
Here the cataljrtic effects of the current, its effects upon the blood-yessels, 
and finer nutritive processes probably come chiefly into play ; perhaps 
something is due to the stimulating and modifying action of the current ; 
as in the various forms of cerebral neurasthenia, insomnia, headache, mi- 
graine, the milder forms of psychical disturbances, in various cerebral 
forms of spasm, chorea, epilepsy, the cerebral disturbances of hysteria, etc. 

Furthermore, in disturbances of circulation in which the effects of 
electrical currents upon the blood-vessels of the brain, which have at least 
been rendered probable by Loewenfeld's investigations, may be utilized, 
as also the more problematical indirect vasomotor effects of galvanization 
of the sympathetic or reflex effects from the integument ; thus in hyper- 
sDmia and anaemia of the brain and the various morbid conditions which, 
in part at least unjustly, have been attributed to them. 

To these may be added hemorrhages into the cerebral substance and 
the foci of softening caused by thrombosis or embolism, in which restora- 
tion of the destroyed nervous elements cannot be looked for, but in which 
the catalytic and vasomotor actions of the current may have a very favor- 
able influence upon the absorption of the extravasations, the furtherance 
of collateral circulation, the removal of secondary conditions and se- 
quences (circulatory and inflammatory disorders), the stimulation of nu- 
trition, and the restoration of the function of the nerve-elements which 
have not been entirely destroyed. 

Finally, a favorable influence of the catalytic action of the current may 
be expected in various chronic, inflammatory, and degenerative processes 



8FB0IAL ELEOTRO-THERAPEUnOS. 147 

in the brain, in chronic meningitis and encephalitis, sclerotic processes, 
various forms of degeneration and atrophy of nerve-elements. 

A favorable influence must be excluded in tumors of the brain, in far- 

^advanced processes of gray degeneration and sclerosis, thickening of the 

meninges, etc. But even here electrical treatment may act favorably 

upon the secondary conditions and sequences of these affections, upon 

which a part of the symptoms depend. 



LECTURE XVL 

DeTttlo|nnent of Eleotro-therapentioal Methods— Direct Treatment of the Brain : Ga*> 
alytio and Vasomotor EffecUi and the Methods of ProdnoiDg them— Stimulating 
and Modifj^ing EfPeota—Teohniqae of the Application of the Galyanio and Faradio 
Cnrrent in Cerebral Diseases— Indirect Treatment of the Brain : Galvanization of 
the Sympathetic — Reflex ££Fects from the Skin— Symptomatic Treatment — Eleo- 
tro-diagnoeis in Cerebral Diseases — Bleotro-therapeutics of Individual Forms of 
Disea«te : Cerebral Neurasthenia ; Insomnia ; Hypensmia ; Anssmia ; Hemorrhage ; 
Cerebral Softening ; Inflammation ; Degeneration ; Sclerosis, eta ; Bulbar Diseases 
— Incurable Cerebral Affections. 

Reflection shows that we must depend chiefly, in the diseases men- 
tioned, upon the vasomotor and catalytic actions of electrical currents. 
The galvanic current, therefore, has a wider field in diseases of the brain 
than the faradic, though the effects of the latter cannot be entirely denied. 

We may endeavor to influence these diseases in various ways — by the 
direct method, by the direct application of the current to the seat of dis- 
ease ; in an indirect manner by vasomotor influence, chiefly by galvaniza- 
tion of the sympathetic ; or in a reflex manner, by peripheral irritation of 
centripetal paths. Finally, an effect produced by special treatment of 
the peripheral parts whose functions are disordered (nerves of sensation 
and special sense, motor nerves and muscles, etc. ) cannot be excluded. 

The special methods of application under these various conditions are 
still based upon a cautious empiricism. 

We must, above all, discuss the direct influence upon the brain. 

With regard to the cataljrtic actions, the nature of the individual path- 
ological disturbances is almost as unknown as the corresponding effects of 
the current from which we expect a cure. There is an especial uncertainfj 
with regard to the action of one or the other pole or one or the other di- 
rection of the current ; the therapeutic experiment is alone decisive. 

With regard to the vasomotor effects, certain points of departure are 
furnished by Loewenfeld's experiments. 

It must be remembered, however, that these were only made on rab- 
bits, that their results cannot be transferred without question to hu- 
man beings, and that they are not sufficiently constant and decisive to be 
regarded as definitive and certain ; above all, however, that it is often 
doubtful as to what condition it were better to secure in the pathological 
ease under treatment Who will venture, for example, to say with oer^ 



SPECIAL ELBCrEO-TmCRAPBUnOS. 149 

teinfy thttt in a hemiplegia from cerebral hemorrliage or embolism it were 
better to secure an hypersemia or anaemia of the afifocted half of the 
bnin? So long as we are uncertain on this point, we will not be able, 
ewea with the aid of Loewenfeld's results^ to pass beyond a cautious trial 

l\iking these difficulties into consideration, we may choose the follow- 
ing methods of influencing the circulatory conditions in the skull and brain : 

To secure a diffuse, equable action upon the entire brain, employ lon- 
gitudinal conduction of the current with broad, large electrodes, Tarying 
the direction according to the desired effect : if you wish to increase the 
flow of blood to the brain and accelerate the circulation, apply the An to 
the neck, the Ca to the forehead ; if the flow of blood is to be diminished, 
the An is applied to the forehead, the Ca to the neck. 

Ibnnsverse conduction of the current (with a suitable choice of the 
points of application), so that the morbid process is situated in the line 
connecting the electrodes, is preferable for localized foci of disease. 
The choice of the pole depends upon the indication ; if the circulation is 
to be accelerated and the vessels dilated, the An is applied to the diseased 
side ; in the opposite event the Ca is applied to this side. 

Nor have we advanced much beyond surmises with reference to the 
stimulating and modifying actions of electrical currents. For who can 
teU with certainly whether the brain is in a condition of irritation or in- 
hibition or paralysis in the various neuroses, or whether the anelectro- 
tonic and oatelectrotonic action of the current also occurs in the brain ? 

We are therefore restricted essentially to this stand-point, viz., that 
we must endeavor to pass the current with sufficient strength and density 
through the entire brain or the focus of diseasa In the first choice of the 
position of the poles and direction of the current, we must naturally be 
guided by the few positive facts based on theoretical considerations — as for 
the rest, the problem consists in developing the technique by a cautious col- 
lection of well-controlled observationa 

The galvanic current is most frequently employed. As a rule, it is 
well to use large electrodes, as the strength of the current is thus in* 
c r e as ed without intensifying its density to too great an extent ; recently 
I employ almost exclusively the large head electrodes {vide page 17). 

The methods of application employed by me are the following : 

a. In order to influence the entire brain, either longitudinally from 
ate forehead to the neck, or obliquely from the forehead and temple of 
one side to the opposite side of the neck and occiput (successively on 
both sides), I have almost always employed the An anteriorly. Occasion- 
ally, in order to secure a more unipolar action upon the brain, I have 
applied a large electrode to the vertex, or passed it slowly from the fore* 
head to the vertex, while the other electrode was applied to the neck, back, 
sternum, a hand or foot 

b. In order to influence a localized morbid process, I employ mainly 



150 ELBGTBO-THEBAPEUnOS. 

the longitudinal conduction from the forehead to the neck upon the af- 
fected side (the An on the forehead) ; then transverse conduction through 
the affected region of the skulL Becentlj I have employed oblique ood- 
duction in such a manner that the morbid process is situated, as far as pos- 
sible, in the direct line between both electrodes ; the An is usually placed 
upon the side of the lesion. 

When the morbid process is very circumscribed, especially when super- 
ficial (in the cortex, injuries to the skull, etc), one pole should be applied 
as directly as possible to the affected spot, the other pole immediately op- 
posite or in some remote part of the body. 

The faradic current may be applied according to the same technique. 
When a very mild application is to be made, you may employ the so-called 
"electrical hand." Your own hand is then employed as an electrode 
(usually the An of the secondary current) by grasping the corresponding 
electrode with the other hand and thus allowing the current to pass through 
your own body ; the hand employed in the application should be well 
moistened ; the other electrode can be applied to any part of the patient's 
body. 

The following general rules should be observed : 

Always employ weak ciurents and begin with very feeble ones. Con- 
trol the strength by the galvanometer (15 to 25^ deflection of the needle 
after introduction of 150 CR), or at least govern its strength by the occur- 
rence of flashes of light and vertigo. This is especially true of the gal- 
vanic current. Do not make rapid openings and closures, still less reversal 
of the current. It is well to remove the electrodes gradually by passing 
them along the hair of the scalp. Short sittings are indicated, half a min- 
ute to a minute and a half at each place, rarely longer. 

In many cases it is advisable to make galvanic ''trial sittings ;** you 
can then readily determine whether the applications will be tolerated. 

Indirect treatment of cerebral affections may also be employed. 

Galvanization of the sympathetic is the most important in this respect 
In the event of a unilateral lesion the question arises whether the synipa- 
thetio should be treated on one side alone. We do not know with cer- 
tainty that the sympathetic affects the circulation and nutrition of the 
corresponding side of the brain alone ; furthermore, it is probable that 
the so-called galvanization of the sympathetic also affects other jparts, the 
base of Uie skull, pneumogastric, cervical cord (in which decussation is 
partly effected), which may be of importance. It is therefore better to 
treat both sympathetica in all casea 

The method of galvanizing the sympathetic has been previously de- 
scribed (page 111). 

Another method of indirect treatment of the brain is by reflex action 
from the integument ; it should be tried when you desire a distinct action 
upon the cerebral circulation, and may also be useful in various functional 



SPECIAL ELEOTRO-THEBAPEUnCS. 151 

disturbances, insomnia, psychoses, etc., and finally in disturbances of the 
sensory paths of the brain (hemiausesthesia). You may employ either 
stimulation of large surfaces of the integument, or of very circumscribed, 
distinctly localized portions. 

In the first event the faradic brush is vigorously applied for four to six 
minutes, to the back, chest, and upper limbs, perhaps also to the lower 
limbs, the strength of the current being sufficient to produce contraction 
when applied to the median nerve in the fold of the elbow. 

In the other event, a daily application of the faradic binish is made for 
eight to ten minutes, with tolerably strong currents, to a very small part 
of the integument of the anaesthetic or paralyzed side. The upper limb 
(external surface of the forearm) is preferable, because it appears to exert 
a greater reflex influence on the brain than does the lower limb. 

Finally, in very many cases we resort to symptomatic treatment, i.e., a 
peripheral and direct treatment of the main disturbances of function 
(paralysis, contracture, anaesthesia, aphasia, disorders of special sense, etc.) ; 
this is done according to the methods which will be described in the sub- 
sequent lectures. A great many successes have been achieved in this 
manner, for which there are various explanations In the first place we 
may assume reflex influences, which partly affect the vasomotor tracts and 
thus influence the lesion itself, partly the paralyzed motor paths and there 
exert an anti-paralytic action. It is also conceivable, as Brenner has pointed 
out, that various nutritive, molecular, or other disturbances are produced 
in the peripheral parts, either as the result of the brain lesion or from the 
prolonged forced rest and inactivity of the paralyzed parta 



We will now briefly consider the electro-diagnosis of cerebral diseases. 
It may be stated as a general principle that the electrical irritability of the 
motor nerves and musclea usually remains entirely unchanged in cerdmd dis- 
eases^ especially in paralyses. 

To ihis rule there are a number of exceptions, though none of great 
praotioal importance. 

Slight increase of electrical excitability is found not infrequently in 
cerebral, especially apoplectic paralyses, for a short time after their oc- 
cnrrenoe, and also, it is said, when these paralyses are associated with 
contracture. A similar condition is sometimes found in certain spasmodic 
affections which are possibly of cerebral origin, such as chorea minor ; 
whether tetany is to be placed in this class is still doubtful 

Simple diminution of electrical excitability occurs sometimes in hemi- 
plegias acquired during childhood (after encephalitis, hemorrhage, etc), 
in which the growth of the bones and Uie nutrition of the muscles remain 
defective. 

Degeneration reaction occurs when the cerebral nerves suffer a severe 



152 SLECTRO-THSBAPEUTIO& 

lesion at the base of the skull, or when the nuclei of the motor nerves an 
diseased, or finaUj, in very rare oases, when a descending secondary de- 
generation of the pyramidal tract spreads to the anterior gray oolomns of 
the cord, and thus produces degeneratiye atrophy in the domain of epinal 
nerve-tracts. In the very common cerebral paralyses alter hemorrhage or 
embolism the electrical irritability ordinarily remains imohanged, often 
for years, and even delicate methods of examination fail to show the slight- 
est difference between the two sides. 



I will now give a short description of the treatment of individual lonns 
of disease. 

Among the functional disorders of the brain, I will discuss veiy few in 
this lecture ; the most important ones will be discussed in detail in sub- 
sequent lectures. Our attention will be directed mainly to cerebral neu* 
rasthenia the chief symptoms of which are : a sense of pressure in the 
head, dulness, insomnia, loss of desire and inabiUty to work, hypochon- 
driacal and depressed mood, vasomotor disturbances, the various patho- 
logical conditions of anxiety, dyspepsia, palpitation of the hearty ete. 

lu galvanic treatment, very feeble, stabile currents should be passed 
longitudinally, transversely, and obliquely through the head ; perhaps, ac- 
cording to Loewenfeld, the An should be applied anteriorly when evi- 
dences of congestion are present, the Ca anterioily in anaemia. It is 
sometimes useful to apply the current in succession in both directions ; 
this can only be determined by making trial in each individual case. A 
strictly polar method may also be resorted to, one electrode being placed 
upon the vertex and the anterior part of the head, the other upon the feet 
(one to five minutes), or central galvanization according to Beard's method 
(page 118) may be employed. Finally, galvanization of the sympathetio 
and cervical cord is decidedly useful in many cases. 

The most important feature of foradic treatment consists of mild fara- 
dization of the head by means of the " faradic hand " or a large head elec- 
trode, either longitudinally through the head (An anteriorly) or a unipolar 
application to the head, the other electrode being placed upon the feet. 
This is a transition to general faradization (page 116) which is of marked 
benefit in many cases. Rumpf also appears to have secured excellent re- 
sults in some of these forms of disease by means of the farado-outaneous 
brush. 

You should begin in these cases with feeble currents and short sittings ; 
if well tolerated, more vigorous currents may be employed. The galvanic 
sittings should not last longer than one and a half to five minutes, the 
faradic from five to ten minutes, and from three to six times a week. The 
treatment must usually be continued for a long time. 

Insomnia, which is so important a feature to many patients, may be 



SPECIAL ELEOTBO-THSBAPBUnOS. 158 

treated in the same manner ; the same methods may be em^dojed as wen 
described above in the treatment of oerebral neurasthenia. The resolts 
«re often surprising {vide Observation 3). 

Among the grosser anatomical changes in the bndn, the circulatory dis- 
torbances are occasionally the subject of electrical treatment The state- 
ments of Loewenfeld may here serve as a guide : longitudinal conduction 
of the galvanic current through the head, the An on the forehead in hy- 
penemia, the Oa in this position in anaemia. You may also add suitable 
treatment of the cervical sympathetic and spinal cord. The circulation 
within the skull may also be affected by a moderate faradic current passed 
longitudinally through the head (Loewenfeld), or by a reflex action from 
the integument by means of the faradic brush. 

Cerebral hemorrhage, however, is the most frequent and perhaps the 
most important object of electrical treatment in this category. The first 
question which arises i% At what time after the occurrence of the hemor- 
rhage should treatment be begun ? We will do well to disturb nature's 
process of healing as little as possible and to await its development and 
dbeotion. In this disease, I begin electrical treatment about three or four 
weeks after the occurrence of paralysis ; in very mild cases we may begin 
a little earlier, in severe ones somewhat later. 

The galvauio current alone may be employed in the direct treatment 
of cerebral hemorrhages The method of its application consists of lon- 
gitudinal, transverse, and oblique conduction through the head in the 
manner previously described. It is customary to apply the An to the side 
of the. lesion ; the duration and frequency of the individual applications 
should be those ordinarily adopted. Bilateral galvanization of the sympa- 
thetic is then employed in the ordinary manner. 

In old cases, especially when associated with contracture of the par- 
alyzed parts, it is advisable to employ oblique conduction, because the 
entire motor paths as far as the pyramids are thus affected ; iq>plication8 
may be made also to the spinal cord, as I shall describe later. 

In addition, peripheral symptomatic treatment should scarcely ever be 
neglected. To relieve the paralysis resort to labile application of the Ca 
(An in the neck) and repeated cathodal closures, or to faradization of the 
paralyzed nerves and muscles. Ansesthesia may be combated by the same 
procedures or by the methods of Yulpian and Bnmpf . To relieve the con* 
traatures, you may repeat the experiments of Bemak, securing relaxation 
of the muscles by powerful stabile currents or repeated interruption of the 
ourrent or by very vigorous faradic currents ; or, according to Lange, vig- 
orous &iadization of the contractared muscles, then passive stretching, 
fixation of the limb upon a splint in forced extension, and finally mild 
ftundization of the more markedly paralyzed antagonists (the exten- 

The results of electrical treatment in cerebral hemorrhage and its 



154 ELBOTBO-TH£BAPEUnOS. 

quelsB are so Tariable that accurate statements cannot be made 
regard to them ; at all events, a trial is justified in almost all casea 

Softening of the brain from thrombosis and embolism, ansemic necroas 
-mih its usual results, from the apoplectic attack to hemiplegia with cod- 
tractures, ansBsthesia, aphasia, etc., should be treated in the same manner 
as hemorrhages — so much the more because we are often unable to make 
a positive differential diagnosis between the two forms of apoplectic 
hemiplegia. 

The electro-therapeutic measures are, in general, similar in the other 
anatomical lesions of the brain, such as inflammation, degeneraticHis, 
atrophy, sclerosis, hydrocephalus, etc. 

In the more diffuse forms of disease (chronic nieningitis, difiuse peri- 
encephalitis, multiple sclerosis, hydrocephalus, etc.) it is advisable to em- 
ploy longitudinal or bilateral oblique conduction through the skull with 
very large electrodes (with varying direction of the current on account of 
the desired catalytic action) ; in addition, treatment of the sympathetic 
and the cervical spinal cord. You may also make trial of reflex influence 
from the integument, and also of general faradization and central galvan- 
ization. 

In distinctly localized diseases the applications naturally must corre- 
spond to the site of the lesion. 

You should not give up hope too readily in such cases. Unexpected 
improvement and recovery sometimes occur, even in severe organic dis- 
ease& I remember three cases in which severe organic lesions were 
undoubtedly present (with choked disk, amaurosis^ violent headache, 
vomiting, partial paralysis and spasms, etc), so that the diagnosis of 
tumor could be made almost with certainty, and in which, contrary to all 
expectation, persistent improvement and almost recovery occurred ; and 
another case of apparently hopeless, severe disease of the brain (and the 
meninges) with severe epileptic attacks, advanced dementia, general se- 
vere tremor, paresis of the limbs with muscular contractures and in- 
creased tendon reflexes, etc, in which a remarkable improvement in all 
respects was secured by a year's treatment (electrical and medicinal). 

I will now make a few remarks with regard to bulbar diseases, llie 
most frequent form, viz., progressive bulbar paralysis (progressive muscular 
atrophy in the domain of the motor nuclei of the medulla oblongata), must 
be regarded as incurable ; the cures reported by Benedikt refer to other 
forms of disease. But there are certain varieties of bulbar disease in 
which electricity often effects favorable, even brilliant results. I have pub- 
lished a number of cases of this kind (vide Observations 16 and 17), and 
some of Benedikt*s observations belong to this category. 

The method of treatment — the direct treatment by means of the gal- 
vanic current alone — consists of stabile, transverse conduction of the 



SPECIAL SLEOTBO-THSRAPEUnCS. 155 

enrrent through the mastoid processes (with Tarying direction of the 
current, as the disease is usually bilateral), or in longitudinal conduction 
from the forehead to the neck, or finally, oblique conduction. This is sup- 
plemented by galvanization of the sympathetic and the cervical spinal cord 
(ascending or descending currents, stabile and labile, through the cervical 
vertebrae, from the upper dorsal vertebrae to the neck). In the majority 
of cases it is very useful to secure a series of movements of deglutition 
(10 to 20 at each sitting) in the manner previously described ; further- 
more, peripheral galvanization and foradization of the neuro-muscular 
tract specially involved in the paralysis and atrophy. 

The treatment of these bulbar affections generally requires feeble cur* 
rents, short sittings, and long continuance. 

In really incurable cerebral diseases you will rarely produce ameliorar- 
tion by means of the electrical current, but you may fdways attempt, in 
the manner previously indicated, to alleviate individual symptoms, such as 
headache, insomnia, mental depression, or ansesthesia and paralysis, eta 



APPENDIX. 



ELECTRO-THERAPEUTICS OF THE PSYCHOSE& 



LECTURE XVIL 



fiBteodnotion — InTestigations of Amdt and their Resolte — Short IU8am6 of the Llt«i»> 
tare — Available Effects of the Electrical Current — Roles and Methods of Electrioal 
Treatment of Individoal Forms of Psyohoees — Treatment of Indiyidoal Sjmptoma. 

Thb electrical current^ with its various therapeutical effects, appears 
destined to unfold a favorable curative influence upon the pGfychoses, espe- 
cially the initial forms or incipient stages, in which we have to deal mainly 
with functional disturbances or finer nutritive, molecular changes in the 
brain, or in which, with our present methods of examination, we can, at 
the most, demonstrate changes in the circulation. Even in those cases in 
which grosser anatomical lesions (chronic, inflammatory, and degenerative 
processes) constitute the basis of the psychosis, a favorable action of the 
electrical current cannot be absolutely excluded, if we may reason from 
analogy. 

Amdt is the only observer who has busied himself systematically and 
in detail with this subject, and he has arrived at the following conclusions 
with regard to the chief indications : 

" Only such psychical disorders as depend upon so-called functional 
disturbances, or on temporary anomalous nutritive processes, or on circu* 
latory derangements, can be cured by electrical currents ; they may also 
be useful in deeper-seated organic changes, if we seek amelioration 
merely.'* 

"Electrical treatment is therefore specially adapted for fresh cases; 
rather for the milder, vague forms than for those which are characterized 
by violent symptoms" 

" General and especially a marked psychical hypersesthesia constitutes 
a contraindication to the employment of the electrical current." 

*' The faradio current simply acts as a stimulating measure ; it acts 
successfully, especially in simple conditions of depression, whether they 



8PECIAL ELBOTBO-THERAPBDTICS. 157 

hKW de^loped jirimarily or as the result of prerious viole&t proeasses. 
It is employed almost exdusiyely as cutaneous irritatiiMi of ^various poir- 
ikms of the akin ; occasionally as faradization of the phienic nerve% ia 
order to stimulate the circulation and oxidation of the blood." 

" The galvanic current also possesses other effects (alteratiye, sedati^is, 
catalytic) ; its sedatire and soporific action appears to be eepedaUy 
marked ; it is therefore ayailable in almost all other psychoses which are 
open to galvanic treatment The method employed, howerer, is by bo 
means immaterial, and must often be determined empirically. If marked 
conditions of irritation, especially in the domain of circulation and res- 
piration, are present, the descending current should be employed ; the 
ascending current is chiefly resorted to in affisctions which indicate paraly- 
sis of the vascular system. The descending current, ue.^ the polar action 
of the An, therefore appears mainly indicated in the early stages of the 
psydioses, the ascending current, i,e., the polar action of the Ga, in the 
terminal stages, especially of the more severe affections." 

'' But the current should not be applied to the head in the insane, but 
rather to the spinal cord (and medulla oblongata), vdth its important vaao> 
motor, circulatory, and respiratory centres, and perhaps to the peripheral 
nerves (if these present irritative conditions, neuralgia, etc.). Galvaniza- 
tion of the head is not absolutely excluded, but is confined to those cases 
in which we desire temporary stimulation or sedation." (In his later 
experiments Amdt resorted regularly to galvanization of the head.) 

*^ Success usually follows only after long-continued treatment ; the 
strength of the current must be sufficient and the duration of the appli- 
cation sufficiently prolonged (ten to thirty minutes)." 

By means of peripheral &radization of the skin and muscles in various 
parts of the body Amdt cured several cases of conditions of simple de- 
pression and marked apathy, in part in a remarkably short period. 

With the chief or exclusive application of the galvanic current to the 
cervical cord and the peripheral nerves, a few cases were cured which pre- 
sented various psychical disturbances (conditions of depression and exal- 
tation), but which were characterized in common by various somatic condi- 
tions of irritation, increased sensitiveness, abnormal sensations, pupillary 
changes, digestive disorders, constipation, and especially vasomotor dis- 
turbances. The stabUe action of the An was particularly useful in these 
casea 

In another series of cases which were favorably influenced Amdt also 
brought the head itself, in addition to the cervical cord, sympathetic, 
pneumogastric, etc., under the influence of one pole (usually the An), v?hile 
the other was placed at a distance (small of the back, thighs, hands, feet), 
lliese were cases of varying character — conditions of exaltation and 
depression, feelings of severe fright, several cases of severe katatonia, 
hysterical psych6ees, reflex psychoses, eta ; but almost all of which had 



158 ELEOTRO-THERAPKUnCS. 

dereloped upon a neuropathic and psychopathic baoB, and in great 
part showed symptoms of irritation and irritable weakness in the distri- 
bution of the vasomotor and circulatory nerves, the pneumogastrics, res- 
piration, the splanchnic and the genital nervea As a rule, the action at 
the An upon the central nervous system was the most favorable ; but 
Amdt also observed some cases in which its action was injurious, while the 
Ca had the desired effect. The choice of the method must therefore be 
modified, according to the occurrence or non-occurrence of a sucoeaafol 
result 

Franz Fischer saw a case of severe hypochondriacal melancholia, with 
vivid hallucinations of all the senses, relieved in a short time by galvaniza- 
tion (longitudinally and transversely through the head) ; this observer also 
had a very fevorable result from general faradization in a case of melan- 
cholia, with forced ideas and severe vasomotor symptoms, which had lasted 
for years ; great temporary relief followed the first sitting, became perma- 
nent after the fifteenth, and advanced to recovery. 

Engelhom also observed admirable results from the same method in 
two cases of epileptic and hysterical insanity. 

In general paralysis of the insane very slight beneficial effects were 
produced and these lasted but a short time. 



Careful consideration shows that the greatest weight must be attached 
to the catalytic action of the galvanic current in the treatment of insanity 
by electricity. Next in importance are undoubtedly the vasomotor effects 
of electrical currents, especially of the galvanic ; it is a matter of experi- 
ence that vasomotor disturbances play a predominant part in the develop- 
ment and symptomatology of many psychoses. It seems tome that much 
less can be expected from the modifying action of the current, and I must 
regard as premature the view of Amdt that all the effects of the galvanic 
current must be attributed to anelectrotonus or catelectrotonus of the cen- 
tral nervous system. We should be satisfied at present with facts, and 
should endeavor to multiply and sift these, instead of resorting to hypo- 
thetical explanations. Finally, that the stimulant action of electrical cur- 
rents may be utilized in psychiatry is proven with regard to the peripheral 
irritation of the cutaneous and muscular nerves, from which a modifying 
action upon the functions and circulation of the central organs may be 
expected. 

I have had too little experience in this wide and difficult field to be 
able to furnish definite rules for the electrical treatment of the psychoses ; 
I must therefore restrict myself to brief hints upon the subject. 

You should employ electricity mainly in recent and relatively mild 
cases, especially the more vague, not fully developed psychopathic condi- 
tions, conditions of morbid fears, with sleeplessness, etc. Hie most suit- 



SPECIAL ELECTRO-THERAPEUTICS. 159 

aUe method in such cases is simple longitudinal (or oblique) conduction 
through the head, and at the same time galvanization of the sympathetic, 
perhaps of the cervical cord. 

If such cases are associated with profound amemia, general debility, 
impaired digestion, etc., it is justifiable to try general faradization, per- 
haps alternating with the galvanic treatment. 

In severe, fully developed cases, in profound melancholia, in stupor and 
allied conditions, katatonia, hysterical and reflex psychoses, etc, you may 
employ a sufficiently energetic imipolar action of the galvanic current 
upon the head, neck, sympathetic, etc., the indifferent pole being applied 
to the head and abdomen ; the intensity and duration of the current 
should be gradually but cautiously increased. The choice of the active 
electrode will depend particularly upon the quality of the somatic (espe- 
cially the vasomotor, circulatory, and respiratory) disturbances present 
and the direction — exaltation or depression — of the psychical anomalies ; 
in marked irritative conditions use the An ; on the other hand, the Ca 
should be employed in depressed and torpid conditions, in symptoms of 
vasomotor weakness and paralysis. But do not forget that everything de- 
pends upon actual experiment, and that sometimes that pole is effective 
which is opposed to your theoretical considerations. 

If the methods described do not prove successful, others may be re- 
sorted to. In conditions of stupor and in simple depression the faradio 
current is also suitable in the form of electro-cutaneous irritation of vari- 
ous parts, or, better still, in the form of general faradization. 

In periodic melancholy galvanization of the head should be employed 
during the intervals of the attacks, perhaps also the continuous applica- 
tion of a simple galvanic element to the head (i>age 120), in order to pro- 
long the duration of the interval if possible. In dementia paralytica very 
littie can be attained by electrical treatment. 

In conditions of profoimd excitement, such as acute mania, etc., elec- 
trical treatment should not be employed. It is also contraindicated in 
general nervous hypersesthesia, and especially in psychical hypersesthesia, 
^en the mere attempt at electrical treatment throws the patient into a 
state of great anxiety and excitement. 

In many insane x>atients you may direct special attention to the treat- 
ment of individual symptoms of the psychosis. Thus, for example, in- 
somnia, which may be treat-ed according to the methods above described 
(page 152) ; furthermore, hallucinations, especially of hearing, the treat- 
ment of which will be described at a later period. 

Morbid fears are sometimes relieved by faradization or galvanization of 
the epigastric and prseoordial regions. 



IL DISEASES OP THE SPINAL CORD. 



LECTURE XVIIL 

Intzodaoiion— Phjsiologioal and Theoretical Baaia for the Eleotro-tberapeatieB of tte 
Spinal Cord—Therapeatioal Data; Selected Caaea — Condiiaiona therefrom— 
Therapeatic Failurea— Forma of Spinal Diaeaae in which Blectro-therapeutio 
Snooeaa may be Expected — Methods and Technique of Eleotro-therapeatioB of 
the Spinal Cord — Direct Treatment : Action cf the Polea and the Direction of the 
Current — Methoda of Application in Ciroumaoribed and Longitudinal Dinaaaaa 
Indlteot Treatment : From the Sympathetic ; Combined 'treatment of the 
Sympathetic^ — Ueflex from the Integument— Diplegic Irritation— Treatment of 
Pointa of Preaaure and Pointa Doloureuz—Symptomatic Treatment. 

Lf the electro-therapeutics of diseases of the spinal cord we stand upon 
a somewhat firmer basis than in that of cerebral diseases. The awBober 
of positive successful oases is so great that the electrical current has se- 
cured an assured and prominent place in the treatment of ehrooic d i ae ooce 
of the spinal cord. And the entire electro therapeutics depends, in the 
main, upon clinical and therapeutical experience. 

Our physiological data with regard to the efiEects of electricity upon 
the spinal cord are extremely scanty, as is evident from the remarks made 
in a previous lecture (page 54). 

But our general knowledge of the action of electrical currents, numer- 
ous therapeutical experiences concerning the peripheral nerves and other 
parts of the body, justified us in the same manner as it did in diseases of 
the brain (Lecture XYI.) in expecting an entire series of definite curative 
effects upon the diseased cord, although we possess much fewer experi- 
mental data than we do with regard to the brain. 

Thus, in not a few cases, we might expect from the catalytic action of 
the current a favorable influence upon minute and gross nutritive disturb- 
ances, upon the various forms of inflammation and their sequdss, the 
chronic degenerative processes, the so-called functional diseases of the 
^inal cord and the like. No less available do the vasomotor actsons of 
electrical currents appear to be in circulatory derangements and for the 
purpose of relieving nutritive disturbances, etc , and so much the more, 
since recent experiment sindicate with increasing certainty that the cir- 
culation of the organ may be affected indirectly (less by means of vaso- 



SPECIAL SLSOTROTHEBAPEUTICS. 161 

motor x>ath8 and the sympathetic than in a reflex manner from the skin). 
Finally, the currents may exercise stimulating and modifying actions upon 
the cord in certain morbid conditions (particularly in functional disturb- 
ances, conditions of irritation or debility, certain forms of spasm, f imc- 
tional paralysis). 

But all these a priori considerations were idle speculation so long as 
they were not confirmed by practical experience. 

The following collection of cases (the number of which might haye 
been much increased) afifords proof of such confirmation. 

18. Observation by HUzig. {Myelo-) Meningitis spinalis subacvia. — A sol- 
dier, aged twenty-three years. March, 1865, fell from his horse ; constant 
pain in the back thereafter. May, 1865, pleurisy and a gastric affection 
(ulcer ?). From July, 1865, more serious complaints : pain in the back, ex- 
centric pains in the limbs, general hyperaBsthesia of the integument ; for- 
mic!ition and feeling of numbness in the legs ; partial and general muscular 
twitchings ; diminished motor power ; incontinence of urine. Later, great 
uncertainty of movements, especially in the dark ; can only walk when 
bent over, on account of pains in the back ; poor sleep. Status, January, 
1866 : great feebleness of the movements ; stands bent over ; totters during 
closure of the eyes. Pupils normaL Sensibility markedly disturbed ; 
diminution of tactile sensation, with marked hypersBsthesia ; great tender- 
ness of the spine on pressure. Previous treatment (nitrate of silver, 
iodine, counter-irritation) unavailing. Gkdvanic treatment with descend- 
ing stabile currents through the spine. After eight sittings, quiet sleep 
for seven hours, almost no spontaneous pains, feeling of relief in the legs. 
Daring further treatment it was shown that galvanization of the sympa- 
thetic acts especially favorably upon the general condition. Later, the 
crural nerves were ti*eated with the descending current. After six weeks' 
treatment no more nervous symptoms demonstrable, beyond moderate 
paiu on pressure over several intervertebral spaces. s 

The patient then had a very arduous service for nine months, and 
then, in conseqiience of over-exertion and exposure, had a relapse with very 
marked and severe symptoms, from which he was almost entirely relieved 
in the course of two or three months by similar galvanic treatment 

10. Personal obserixUion, Chronic s<ptmd meningitis (f); congestion of the 
cord (f). — A boy, aged fifteen years, in February, 1870, had " inflammation 
of the brain " (headache, dizziness, vomiting, long-continued unconscious- 
ness). Since then a great deal of headache ; not so well as formerly. 
Since August, 1870, considerable pain in the small of the back and in 
the left side ; since the end of December, 1870, great weakness in the 
leg?, with a feeling of formication and coldness ; upper extremities 
normal. Sleep disturbed ; occasionally vertigo. Status January 20, 
1871 : several lumbar vertebr.e tender on pressure ; movements of the 
lower limbs performed with sufficient vigor, but patient is easily tired ; 
do83 not totter on closing the eyes. Sensibility normal ; reflexes not 
increased. Sight poor, on account of bilateral leucoma. Hearing normal ; 
some tinnitus aurium ^>ilateral simple hyper:Fstbesia of the acoustic 
nerves). G^vanic treatment : 12 elements Stoelirer ascending from the 
back to the cervical sympathetic, 16 elements ascending through the spine, 
the Ca being moved slowly up and down. 
11 



1 62 ELBCTB0THKRAPEUTIC8. 

February 12, 1871. — Remarkable improvemeni Headadie and tinni- 
tus aurium have entirely disappeared ; no pain in the back ; no paraes- 
thesia or weakness of the legs. 

February 18. — Discharged cured. Abnormal acoustic reaction con- 
tinues. 

20. Persona! ohser cation. Spinal concussion {meningeal apoplexy f), — ^A 
l^K>rer, aged fifty-five years. Four weeks ago fell from a tree upon his 
feet and buttocks ; was immediately paralyzed in the legs ; violent diffuse 
pains in the legs and back. The legs remained pai*a]jzed about a week, 
then motion gmduaUy returned, so that he can now walk a little. An.T8th&- 
sia never present. Micturition normal. Pains gradually disappeared. 
Status : distinct weakness of the legs, slow gait, dragging of the feet, no 
ataxia. Can with difficulty stand upon his toes or upon one foot. Sensi- 
bility normal ; cutaneous and tendon reflexes retained ; no distinct atro- 
phy ; electrical excitability simply diminished ; sphincters and upper 
extremities normal Treatment : galvanization of the spine and legs. 
Striking result ; after a few sittings the patient can wfdk well, and is 
discharged cured after twenty-two dsdly sittings. 

21. Observation by Lewin, Complete paraplegia {from actile myelitis f); 
recovery by the use of galvanism, A woman, aged thirty-five years, not hys- 
terical ; sick about three weeks ; fever, weakness, and numbness of both 
logs, slight shooting pains ; at the end of a week, sudden complete paralysis 
of the lower limbs, violent lancinating pains, girdle feeling, paralysis of the 
sphincters. Reflexes normal ; sensibility not markedly affected. Treat- 
ment with stabile descending currents. After five days, pains disappeared ; 
the left leg can be raised somewhat The paralysis of the sphincters dis- 
appeared in two weeks. At the end of a month, the patient can raise both 
legs and stand a few minutes ; the fever has ceased. At the end of seven 
weeks, the patient walks freely aroimd the room, though with a somewhat 
dragging gait. 

22. Personal observation, Ti'aumatic paraplegia. — A soldier, aged twenty- 
three years, received a bullet-wound in the cervical vertebrae at the battle 
of Worth, August 6, 1870. Immediately afterward, complete paralysis and 
ansBsthesia of the lower limbs, and as high up as the thorax ; retention of 
urine, later incontinence, which disappeared at the end of four weeka 
Motion and sensation gradually improved, especially in the left leg. Status 
on October 20, 1870 : the spinous processes of the sixth and seventh cervi- 
cal vertebrflB tender on pressure ; sensibUity quite restored ; movements can 
be eflected with the left legr, but with little power and certainty ; the right 
leg still very paretic ; frequent clonic movements of the legs, especially 
the right (ankle-clonus). Bowels and bladder normal Electrical excita 
bility well preserved in the lower limbs. Galvanic treatment : stabile cur- 
rents through the spine, special attention being paid to the injured parts ; 
then the An in the neck and Ca labile along the nerves of the legs. Im- 
provement now progresses very rapidly ; after the seventh sitting the 
patient can stand a little on the left leg, and move the right leg more 
freely. After the tenth sitting he can walk around his bed ; after the 
twelfth he can stand securely and walks a few paces ; after the sixteenth 
he walks to the place of treatment, being aided merely by a cane. After 
the fortieth sitting he walks very well with a cane, the right leg being still 
dragged a httle. 

23. Observation by Seeligmudler. Myelopathy , tabes dor8alis{t), — ^A 
mason, aged forty -two yeara Two years ago had a second attack of " par- 



SPECIAL ELECTRO-THERAPEUTICS. 163 

alysis," which still continues. Gkit uncertain and tottering ; walks with the 
aid of a oane ; drags the left leg, weakness of the right arm ; violent tottering 
upon closure of the eyes. Pain in neck and small of back ; parsesthesia of 
hands and feet ; cincture feeling ; anaesthesia of hands and anaesthetic zone 
in neck from the spine of scapula to the vertex. Impotence ; weakness of 
bladder ; constipation. Gralvanic treatment : 10 elements descending 
through the spine, ten minutes every day. Wonderful effect after the 
first sitting ; pam less, sensibility improved ; for the first time in a long 
period patient walks across the street without a cane. After the fifth sit- 
ting, the gait evidently improved, tired feeling disappeared ; sleeps well ; 
sensibility almost normal. After fourteen sittings patient discharged 
oared ; after eighteen months improvement still continues. 

24. Observation by von Krafft-Ebing. Tabes dorsalis, — A butcher, 
twenty-six years old. Sick for a year ; parsesthesia of the legs, with weak- 
ness and increasing uncertainity of gait ; lancinating, boring pains in the 
lower limbs; uncertainity in the dark in going up stairs and turning 
around, can only walk with the aid of a cane. Bladder and rectum normal 
Patient presents marked ataxia of the lower limbs ; gross power retained ; 
can only walk for about five minutes with the aid of a cane. Totters violently 
when the eyes ai*e closed ; circumscribed anaesthesia, chiefly in the right 
calf and foot. Galvanic treatment : stabile current along the spine a few 
minutes eveiy day, with labile stimulation of the peroneal nerve. Distinct 
improvement after the fourth sitting. At the end of five weeks the treat* 
ment had to be discontinued ; improvement very marked ; sensory dis- 
turbances entirely disappeared, no tottering upon closure of the eyes ; 
power and endurance of the legs have returned, the patient can walk one 
at two hours and follow his trade. 

25. Personal observation. Tabes dorsalis, — A tailor, aged thirty- three 
years. Previously had chancre ; for past eight years typical lancinating 
pains, irritable weakness of the genital organs, tremor of the legs ; for 
past three years, weakness of the legs, uncertain and jerky gait ; parsesthe- 
sisB. Bapidly grew worse three or four months ago. Status: marked 
ataxia of the legs ; cannot stand alone ; gross strength somewhat dimin- 
ished. Cutaneous sensibility of legs greatly lowered ; marked slowness of 
oonduction of pain, with persistence of the sensation. Muscular sensibihty 
glreatly diminished ; falls upon closure of the eyes. Cutaneous reflexes 
absent. Weakness of the bladder ; impotence. " Upper limbs, brain, and 
cerebral nerves normal Gkdvanic treatment : 12 elements ascending from 
spine to sympathetic with changing position of anode ; 18 elements as- 
cending tlurough the spine daily, with changing position of cathode ; on 
alternate days, descending Ca labile through the nerves of the legs (nitrate 
of silver at the same time). At the end of a week patient feels easier 
Mid has greater certainty of gait. At the end of a month gait further 
improved, the lancinating pains much slighter ; in a month and a half 
he walks alone with the aid of a cane. At the end of two months he 
can walk alone up and down stairs, and sensibility has improved objec- 
tively. Improvement continues for three months, when treatment was in- 
terrupted. Recovery progressed for six months, but was by no means 
complete. Patient walks alone without a cane, rapidly but still ataxic ; 
can stand with feet in apposition; slight sensory disturbances present 
Tendon reflexes still absent 

:<J6. Personal observation. Beginning locomotor ataxia {f) ; atrophy of the 
cpHc nerves, — A woman aged tfaLrty-seven years. Oradually increasing im- 



1 64 ELECTRO-THEB APEUnOS. 

pairment of vision during the past few months ; shooting pains ; formicaiion 
of the legs ; rapidly grows tired on standing and walking. Sphincters nor- 
mal. Status, January, 1874 : marked amblyopia, color-blind to red, dimin- 
ished field of vision ; ophthalmoscope shows atrophy of opUc nerve& Legs 
weak, gait tottering, slight dragging of right foot ; stands readily on left 
foot, with difficulty on the right No tottering upon closing the eyea Local 
anaesthesia on dorsum of right foot and the toes, sensibility otherwise 
normal. Upper limbs, brain, etc., normal. Simple diminution of electrical 
excitability in the peroneal nerves. Ghdvanic treatment: 14 elements 
from the spine to the sympathetic on both sides ; IS elements ascending 
stabile and labile through the vertebral column ; 8 elements stabile from 
the neck to the closed eyelids. Considerable improvement after eight 
sittings; pains much less, sensibihty distinctly improved, patient walks 
much more securely. Marked improvement after thirty sittings ; x>atient 
can walk up two flights of stairs vnthout difficulty, walks more rapidly and 
securely ; pains and formication have disappeared ; no sensoiy disturb- 
ance demonstrable objectively; eyesight somewhat better. After the 
forty-fifth sitting (June, 1874) continued improvement; walks and goes 
up stairs quite well ; no pain or numbness in the legs. Sensibility objeo- 
tively normal, eyesight slowly improving; ophthalmoscopic appearances 
the same. 

27. ObtiervcUion by if. Meyer, Locomotor ataxia ; treatment of painful 
points on the spine, — A lithographer, aged forty one yeara Suffers from 
ataxia, cannot walk or stand without help ; paresis of the bladder and rec- 
tum ; panesthesia and poor power of localization in legs and soles of feet ; 
disturbed sensation in the ulnar nerves ; lancinating pains in the legs and 
pain on pressure upon the fourth to sixth dorsal vertebrae. Gralvanic treat- 
ment of painful points with stabile An enabled patient, after four to five 
weeks, to walk for hours. Two years later, a relapse occurred in conse- 
quence of exposure ; favorable effect of similar treatment, though not so 
rapid or complete ; some symptoms remained, but patient recovered com- 
plete motor power. 

28. Observation by Drissen, Locomotor ataxia ; treatment of a painful 
point. — A man, aged fifty-two years. Suffering for six years from lancinat- 
ing pains ; increasing ataxia ; gait very uncertain, falls on closing eyes ; 
anaesthesia of soles of feet. Tenderness on pressure over the first lumbar 
vertebra. Treatment : application of An to this vertebra, the CJa on the 
right and left ilia alternately. After fifth sitting tottering on closure of 
eyes, scarcely noticeable ; anaesthesia of soles of feet disappeared ; patient 
walks long distances without feeling tired ; considers himself well and dis- 
continues treatment. 

29. Observation by Brenner, Tabes dorsalis ; treatment of iminful points on 
the spine,— A. laborer, ap^ed forty-two years. Marked tabes for past year ; 
had syphilis, diplopia, lancinating pains, weakness of bladder, etc., fol- 
lowed by distinct ataxia, analgesia, absence of tendon reflexes, etc. Cinc- 
ture feeling well marked in two places, one around the thorax, the other 
around abdomen. Galvanic examination with the Ca reveals very painful 
spot from second to fifth dorsal vertebrae and another from first to third 
lumbar vetebrae. After treatment for two weeks with the stabile An, the 
upper painful spot disappeared and with it the girdle feeling around the 
thorax ; after three weeks* further treatment lower painful point is consid- 
eribly improved. Great improvement in remaining symptoms. (Patient 
also ti'eated peripherally with the faradic current) 



SPECIAL ELEOTRO-THERAPBUnOS. 1C5 

30 ObservcUion by M. Meyer. Affection of spinal cord (tabes f) ; 
treatment with the faradic brush. — ProfessioDal man, aged fifty-four years ; 
suffering for many years from weakness of limbs, periodic violent head- 
ache, pains in back and limbs ; numbness of the legi and bladder trouble 
began quite suddenly. Patient cannot stand well nor walk without assist- 
ance ; totters on closing the eyes ; cincture feeling ; partial anaBsthesia of 
limbs, incontinence of urine. Treatment : faradic brush to the limbs with 
a distinctly perceptible current. After twenty sittings, patient can again 
walk long distances, use the hands in writing ; pains much slighter. Im- 
provement continued for several years. 

3J. Observation by Bump/. Tabes dorsalis ; treatment with the faradic 
brush, — A laborer, aged forty years ; no syphilis. Had lancinating pains 
for eleven years, with increasing diminution of power ; a violent gastric 
affection (gastric crisis ?) was followed by great weakness of legs, abnormal 
sensations in feet and hands, girdle feeling, weakness of bladder ; finally, 
patient could only walk a short distance with the aid of a cane. Examin- 
ation showed ataxia of upper and lower limbs, with retained motor power ; 
analgesia of entire body, diminution of tactile and temperature sensation, 
absence of tendon reflexes. Robertson pupil not present. 

Treatment with the faradic brush : An to the sternum, brush to the 
back and limbs, for ten minutes every other day. At the end of a month, 
marked improvement in every respect, merely uncertainty in walking and 
tired feeling present. Faradic brush now ^temated with galvanization 
of the spine, and five weeks later, patient discharged as well and able to 
work. Tendon and plantar reflexes still absent. At the end of a year 
improvement had continued. 

82. Personal observation. Spastic spinal paralysis {chronic dorsal mye- 
litis ?), — A woman, aged thirty years. Sick for five years ; weakness of the 
legs, with feeling of numbness and coldness ; gradually growing worse ; 
lately weakness of arms ; complete inability to stand and walk for past six 
months. Sphincters normal. Status : lower limbs very paretic, legs stiff; 
on passive motion, very violent muscular contractures ; increased tendon 
reflexes (ankle-clonus). Sensibility scarcely disturbed ; cutaneous re- 
flexes somewhat increased. Gklvanic treatment of spine, including the 
sympathetic : surprising result ; marked improvement at end of five 
weeks ; legs much stronger, muscular spasms almost disappeared. Gkdt 
still awkward and stiff Two months later motion much better, though 
not entirely normal ; patient still feels very weak, but can walk alone and 
go up the staii*8 Slight muscular spasms and foot clonus still present. 
Patient dischaiged. 

33. Personal observation. Subacute anterior poUo-myelitis. — A man, 
aged forty-seven years. Tired feeling in legs for a long time ; taken sick 
in the beginning of October, 1878, with slight fever and feeling of heavi- 
ness and pains in lower limbs ; next day, great weakness, so that 
he was compelled to walk very slowly ; the following day he fell while 
walking, and in a week had complete paralysis of the legs, which only 
lasted a week, when a few movements gradually returned. No parses- 
thesia or disturbance of sensibility ; bladder normal Slight numbness 
in the hands and pain in the arms. Status at end of November 1878 : 
head and upper extremities normal ; slight depression of first intercostal 
space. Lower extremities : marked paresis in distribution of both crural 
nerves ; adductors paretic, also muscles in distribution of tibialis ; sensi- 
bility normaL Cutaneous reflexes retained ; tendon reflexes absent. The 



} 



166 ELECTROTHSRAPBUnOS. 

paretic muscles more or less atrophied and very tender on pressiue. 
Complete or partial DeB in all the muscles of the lower limbs. Galvanie 
treatment: 20 elements ascending and descending through the spine, 
especially over the lumbar enki^ement; 24 to 26 elements Ca la- 
bile with change of polarity in the nerves and muscles of the leg& 
At the end of ten days patient walks around the room, feels stronger ; 
the muscles are firmer and not so tender on pressure. Treatment 
continued, with intermission of a month, until February 6, 1879, when 
patient is discharged almost cured. Motor power excellent ; De R only 
noticeable in distribution of peroneals ; tendon reflexes still absent. Later, 
complete recovery. 

34. Personal observation. Chronic anterior poliomyelitis. — An engineer, 
aged thirty-six years. Taken sick in February, 1877, with pains in the left 
arm, with diminution of power and atrophy. End of August, similar 
symptoms in left lower limb, then in the right ; sphincters normal. 
Status (end of November, 1877) : marked paresis of both legs, no ataxia or 
sensory disorder. Miiscles veiy tender on pressure. Cutuieous reflexes 
feeble ; tendon reflexes very vigorous. Trunk and right upper limb 
normal ; left upper limb paretic and atrophied, sensibility normal Par- 
tial De R present. Treatment : stabile galvanic current to spinal colunm. 
Distinct improvement after three sittings. The improvement continues, 
the De R gradually disappears, the muscles grow firmer and larger, and 
at the end of March, 1878, the patient may be regarded as almost cured. 

35. Personal observation. Progressive muscular atrophy. — A brewer, 
aged twenty-six years. In vdnter of 1872-3, noticed slight weakness 
of right hand, with formication and occasional twitchings in small muscles 
of the hafid ; slight weakness of right shoulder ; gradual depression of 
interosseous spaces of right hand. During last year and a half, sim- 
ilar condition of left hand. Recently, a certain weakness of the legs. 
Status (May 1, 1879) : slight main en griffe on right side ; marked 
atrophy of lower third of right forearm, with numerous fibrillary contrac- 
tions ; arm muscles feeble with fibrillary contractions. Left upper limb 
presents same appearances to less extent. Dynamometer, right 13^. left 19°. 
Sensation normal. Nothing abnormal in the legs ; partial atrophy of 
some of dorsal musclea Partial De R in the markedly atrophic musclea 
of the hand. G^vanic treatment : galvanization of the sympathetic ; then 
An stabile to lumbar and cervical enlargements, followed by Ca in same 
position. Then An in neck, Ca labile through the nerves and muscles of 
upper limbs, especially in forearm and hand. June 7th (after twenty-six 
sittings), decided improvement ; dynamometer ,right 19^, left 33° ; arms 
evidently stronger ; can do more with his hands. 

* 

The fact should not be concealed that the electrotherapeutics of dis- 
eases of the spinal cord presents an extraordinarily large number of fail- 
ures, indeed, much larger than the successes. This is to be expected, 
however, from the nature of the diseases in question. 

The observations related above teach us that a favorable effect may be 
produced in simple functional disorders (neurasthenia, spinal irritation, 
concussion of the cord, perhaps also in acute ascending pandysis, etc.) ; 
also in circulatory disorders (hypeKPmia, anaemia, increased transudation) ; 
finally, a favorable effect may be expected in all kinds of nutritive disturb- 



SPECIAL ELE0TRO-THBRAPEUTI08. 167 

ances and grosser anatomical changes (as in the sequelse of acute menin- 
gitis and myelitis, in the chronic forms of these imflammations, in 
compression-myelitis, sclerosis, gray degeneration, atrophy, etc.). 

We must confess, however, that there is an entire series of morbid 
processes in which we can hope for nothing from electro-therapeutics, for 
example, in old, far-advanced, chronic inflammatory* and degenerative 
changes, in severe contusions and hemorrhages with their sequelse, neo^ 
plasms, formation of cavities, etc. 

Various methods are employed in order to attain therapeutic results. 
The spinal cord may be treated either directly or indirectly. 

In the former method, the galvanic current is employed almost exclu- 
sively, since in the majority of cases we require its vasomotor and catalytic 
actions.^ Indeed, the faradic current has, for a long time, played a very 
subordinate part in the treatment of chronic diseases of the spinal cord. 

The most important and indispensable condition is that the current be 
allowed to act upon the diseased part with sufficient strength, intensity^ 
and duration. 

The influence of the individual poles is still undecided ; they are prob- 
ably equal with regard to the catalytic and vasomotor effects, while they 
vary with regard to the stimulating and especially the modifying effects. 
The (dioice of the poles must therefore be made according to general prin- 
ciples, but should nevertheless be controlled by therapeutical experiment 
in each individual case. 

Still less do we know with regard to the influence of one or the other di 
rection of the current^ though most electro-therapeutists incline to the view 
that one or the other direction is preferable in the treatment of certain forms 
of disease. Thus, I prefer the ascending current in conditions of spinal 
debility, chronic degenerative processes, etc., and the descending current 
in irritative conditions ; frequently both directions may be employod al- 
ternately, in order to intensify the action upon the cord. 

Taking these principles into consideration, the method of application 
in individual cases follows of itself ; the chief requisite is that the current 
pass through the cord with the greatest intensity possible, and you there- 
fore need large electrodes, removed as far as possible from one another 
(vide Lecture IV., page 30). I generally employ my " large " electrodes, in 
very stout persons my " very large " ones. The application should be made 
with the entire surface of the electrode ; if the spinous processes are very 
prominent the electrodes should be applied to each side, the one to the 
right) the other to the left. 

The special method of application depends upon the anatomical condi- 
tions of the individual case, and we may here make a distinction between 
longitudinal diseases of the spinal cord (funicular degenerations, etc.) and 
circumscribed diseases (transverse myelitis, infantile paralyses, spinal 
apoplexy, etc.). 



1 68 ELECTEO-THEBAPEUTICS. 

In the latter it is advisable to cover the entire site of the disease v/iih 
one pole and to apply the other immediately opposite upon the anterior 
surface of the trunk, so that the morbid process is situated in the line of 
connection between the two electrodes. If you think that a purely trans- 
verse conduction of this kind is not sufficiently effective, place one electrode 
over the morbid process and the other as far as possible above or below it 
upon the spinal column ; or under certain circumstances place the elec- 
trodes a Httle above and below the site of disease, as I have often done in 
compression-myelitis with prominent kyphosis. 

In longitudinal diseases (tabes, sclerosis of the pyramidal track, multi- 
ple sclerosis, etc.) it is better to apply both electrodes to the spine, one in 
the neck, the other in the lumbar region. A stabile action is usually de- 
sirable, but the points of application must be changed successively in order 
to bring the entire diseased part under the influence of the current of 
greatest density. This is done by fixing one pole and traversing the en- 
tire length of the spine with the other, and then reversing the proces& 
This can also be done by fixing one pole upon the anterior surface of the 
trunk and successively traversing with the other pole the entire length of 
the spine. 

At present the indications with regard to the choice of poles are very 
indefinite ; the anode is generally preferred when symptoms of irritation 
predominate, in recent active morbid processes, in very irritable and sen- 
sitive individuals ; the cathode, on the other hand, when symptoms of de- 
bility and paralysis predominate, in old, torpid morbid processes (gray de- 
generation, sclerosis, etc.). When a catalytic action is especially required, 
it is best to employ both poles in succession. 

Great caution is requisite, in the beginning, with regard to the intensify 
of the current and the duration of the applications. Only weak currents 
should be employed and the duration of the individual applications should 
not, at first, exceed one to two minutes, so that the entire sitting will last 
four to eight minutes. If the current is well tolerated, you may gradually 
increase its intensity and duration. 

In the indirect treatment of the spinal cord the chief consideration must 
be bestowed upon the so-called indirect catalysis of Bemak, i.e., the action 
upon those vasomotor (and trophic) nerve-paths which have a determining 
influence upon the circulation and nutrition of the organ. For this pur- 
pose, treatment of the cervical sympathetic has hitherto been resorted to, 
with what justice it is difficult to say. However, experience seems to 
teach that treatment of the sympathetic is not devoid of benefit in certain 
affections of the spinal cord ; this is, perhaps, especially true when the pro- 
cess extends into the cervical portion, and the pupils, certain cerebral 
nerves, and the brain itself are affected. I have, therefore, often employed 
a method of application to the spinal cord which influences, at the same 
time, the cervical sympathetic ; the Ca (medium electrode) is placed over 



SPECIAL ELECTBO-THERAPEUTIOS. 169 

the upper cervical ganglion of one side, the " large ** An upon the opposite 
side of the vertebral column, immediatelj adjacent to the spinous processes^ 
at first stabile upon the lower cervical and upper dorsal vertebrsB then 
gradually moving downward and remaining a little while at each place ; 
this method is then repeated upon the other side, one to one and one-half 
minute su£Scing for each side. I then usually apply the Ca stabile upon 
the spinal column, successively changing the point of application while the 
An is held upon the lower lumbar vertebrsB (one to one and one-half 
minute). 

Another method of indirectly affecting the spinal cord is by reflex ir- 
ritation from the integument by stimulating the sensory nerves of the skin. 
This may be done either by means of " general faradization " or by the ap- 
plication of the faradic brush to a large part of the integument of the 
trunk and limbs. 

Finally, the treatment of certain painful points should not be neglected. 
I have discussed this method sufficiently in the general part (Lecture 
XTT., jMigo 119). Whenever painful points (either upon pressure or exam- 
ination with the Ca) are discovered, we should not fail to make them the 
starting-point of therapeutical experiment& 

In addition, an entire series of symptoms of spinal diseases may be 
made the subject of electro-therapeutical measures. These symptoms in- 
clude parsesthesise, ansesthesia;, neuralgias, paralysis, spasms, contrac- 
tures, weakness of the bladder and rectum, spermatorrhoea, impotence, etc. 
The special methods employed in combating these symptoms will be con- 
sidered in subsequent lecture& However, this symptomatic treatment 
may only be regarded as an aid to the direct treatment of the spinal cord. 



LECTUEE XIX. 

TVMtment of lodiyidoal Forms of Splmtl DiBeaae— -Eleotro-diagnottio Pteliminaiy B#- 
inarks>-l. Spinal Meningitia— 2. MeDingeal Apoplexy— 3. Fanotioiud DiacMoaof 
the Gozd ; Gononaeion, Spinal Irritation, Spinal Neurasthenia — 4. Hemorrhageainlo 
the Spinal Cord: Severe Tranmatio Lesions-^. Myelitis; Miilti]^e Bderoais 
6. Tabes Dontolis ; Direct Galvanio Treatment ; Treatment of the Fainfol Poiote ; 
Farado-cutaneous Broah— 7. Spastic Spinal Paralysis — 8. Aonte Anterior PoUoo^ye- 
litis ; Electrical Examination ; Electrical Methods of Treatment — 9. Subacote And 
Chronic Anterior Poliomyelitis — 10. ProgressiTO Mosonlar Airophy ; Gondition of tlM 
Eleotrical Irritability; '^JuTenile" Form ; Method of Treatment ; AmyotropUo 
Lateral Solerosis— 11. Aonte Ascending Paralysis— 12. Secondary DegenesatioBBL 

I WILL now give a brief sketch of the 

Tbbatment of Individual Fobms of Spinal Dibeas& 

With regard to eleotro-diagnosis I will premise that all possible ehsngw 
of electrical irritability may occur in diseases of the spinal cord. Tfaej de- 
pend almost entirely upon the implication of the gray matter in tiie lesimi ; 
if the latter is afifected and seriously injured, the De B, eiffaer partial or 
complete, will appear in the neuro-muscular tracts supplied by it If the 
gray matter of the anterior columns is not affected, no qualitative changes 
will develop, at least no De B ; we may then observe various grades of simple 
diminution, more rarely an increase of electrical irritability. In such 
cases the diminution is caused chiefly by the forced inaction of the mo< 
tor apparatus, in part by the direct influence of the disease. In isolated 
cases, qualitative anomalies of irritability have been observed in individual 
motor nerve-trunks {vide page 91). 

1. Spinal nieningitia only forms the subject of electro-therapeutics in 
its chronic or, at most, subacute forms. The symptomatology may vary 
greatly ; pain and stiffiiess in the back, panesthesisB and excentric pains 
in the limbs, symptoms of motor irritation and weakness, rarely true 
paralysis and atrophy, more or less diffused ansesthesia, weakness of the 
bladder, etc., may occur and are not infrequently subject to great varia- 
tions. The electrical irritability presents no characteristic relation, but 
when the anterior roots are atrophied and degenerated, diminution of ir- 
ritability and De R may occur. 

The treatment depends, in the main, upon the production of catalytic 



SPECIAL ELECTBO-THSBAPEUnOS. 171 

eflEsots, and therefore requires stabile currents, as feur as possible throu^ 
the entire extent of the cord ; both poles are applied to the spine, and 
both are moved successiTelj from the neck to the loins. When irritatin^e 
symptoms predominate, the descending current is allowed to act most 
vigorously, the Ca being placed as low as possible on the sacrum. This 
unipolar action is secured most efifectuallj if the Ca is placed upon the 
anterior surfoce of the trunk. The current should possess moderate 
strength, at least in the beginning ; the sitting may last from four to ten 
minutea 

2. In meningeal apoplexy (sudden, apyrexial occurrence of meningeal 
irritative symptoms with rapidly developing paraplegic paresis or paralysis, 
which usually begins to disappear rapidly) decided benefit can be ob- 
tained m the stage of absorption and beginning convalescence by the ap- 
plication of the galvanic current. The application depends upon the site 
and probable extent of the hemorrhage ; stabile action of the curr^it» 
both poles alternately, is required ; in addition, peripheral treatment <>f 
the paralyzed, anftsthetic, or atrophic parts. 

3. Fun^onal diseases of the cord appear a priori to belong among the 
most favorable objects of electro-therapeutics, but not infrequently our 
expectations are sorely disappointed. In the majority of these cases elec- 
trical examination affords no noteworthy results. 

In concussion qf the cord you will,.as a rule, only be called upon io 
treat its sequelae, either milder functional disorders, weakness^ etc., due to 
finer nutritive disturbances, or more serious and progressive functional 
disorders due to a slow myelo-meningitis (railway spine). In the latter 
event the treatment is the same as in other cases of this kind ; in the ipr- 
mer event we seek in part a direct or indirect stimulation of the spinal 
functions, in part a direct or indirect influence upon the nutritive and cir- 
culatory conditions You may therefore employ various methods of treat- 
ment; galvanization of the spinal column with stabile, not too strong* 
currents, ascending and descending ; the most active pole to be chofu^ 
according to the chief symptoms ; in addition, perhaps symptomatic 
treatment of the principal peripheral disorders. Furthermore, faradisa- 
tion of the spinal column ; also general faradization, especially in general 
debility and poor nutrition, in delicate females, etc. ; finally, perhaps, cuta^ 
neous faradization, especially in the cases in which symptoms of sensoiy 
irritation and neuralgias occur, or in which distinct signs of hypersemia 
or anapmia of the cord are present 

True spinal irritation is extremely rebellious to electrical treatment, 
but brilliant results are sometimes obtained. The treatment may be the 
same as in concussion, but should be employed with great caution and 
very feeble currents. In many cases it suffices to employ an ascending 
stabile current through the spinal column from the small of the back to 
the neck, or in such a manner that the specially painful parts ai*e situated 



1 72 BLEOTBO-THBRAP£nnOS. 

between the poles ; weak currents and short sittings are indicated. The 
anode may also be employed stabile, with a weak current, upon the spe- 
cially painful vertebrsB (three to ten minutes) ; in some cases, however, 
the Ca produces better results. You may also try direct, moderately strong 
fiaradization of the spinal colunm ; also the farado-cutaneous brush, when 
irritative symptoms are prominent, perhaps the application of the faradic 
brush as a counter-irritant over the painful spinous processes ; in some 
cases, general faradization appears to have excellent results. Central gal- 
vanization may also, perhaps, be tried with benefit, espedaUy when cere- 
bral symptoms are present. 

In spinal neurasthenia, the most frequent of all functional spinal di»> 
eases, with its predominant symptoms of debility and exhaustion in aU 
possible districts of the spinal nervous system (motor weakness, x>ane8- 
thesia, sexual exhaustion, etc.), various forms of electrical treatment may 
be applied ; two forms deserve special mention, viz., galvanization of the 
spine vdth ascending stabile currents, perhaps associated with an applica- 
tion to the cervical sympathetic and general faradization, which is credited 
with excellent results in this very field. If these methods do not prove suc- 
cessful, you may resort to the treatment of painful points upon the spine, 
or the cutaneous brush, perhaps to central galvanization. In addition, pe- 
ripheral treatment of the legs and genitals in suitable cases ; perhaps, also, 
of the cervical sympathetic and the head (insomnia, depression, etc). 

4. Hemorrhages into the spinal cord may be treated according to the 
same principles as cerebral hemorrhages. According to the site of the 
hemorrhage, the symptoms consist of paraplegia with anaesthesia, paraly- 
sis of the bladder, with or vrithout atrophy of the muscles and De R. 
Electrical treatment can only be begun when the disease has passed into 
the chronic stage. 

Much cannot be expected from galvanic treatment, but we may hope 
to restore tolerable function to those parts not entirely destroyed by the 
lesion. The site of the latter can usually be determined with readiness, 
and a large electrode should be applied directly over it, first the An then 
the Ca, while the indifferent electrode is applied either above or below 
upon the spine or upon the sternum ; stabile current for several minutes. 
In addition, peripheral symptomatic treatment of ansBsthesia, paralysis 
and atrophy, paralysis of the bladder, etc * 

The same measures vnll serve in severe iraumaJtic lesions of the spinal 
cord (incised or bullet wounds, compression from fracture or dislocation 
of the vertebrae, severe concussion, etc.) if the case has passed into a 
chronic stage of paraplegia. Though much cannot be expected in these 
cases I have often been of service to the patients by the restoration of 
function in individual muscles. 

5. Myelitis in its numerous forms presents various indications in elec 
tro-therapeutics, chiefly in the subacute and chronic forms, since the ap- 



SPECIAL ELEOTRO-THBBAPEUnOS. 178 

plication of the current should be dispensed with in the fresh stages of 
an acute myelitis. 

Apart from those forms which are restricted to the anterior graj col- 
umns and the funicular degenerations (systemic diseases, tabes, lateral 
sclerosis), the ordinary varieties of chronic myelitis (transverse myelitis^ 
multiple sclerosis, central myelitis, compressioD-myelitis, general progres- 
sive myelitis, chronic myelomeningitis, etc.) present but little chance of 
good efifects from electrical treatment But we meet occasionally with 
cases in which it is of very evident benefit and in which even complete re- 
covery is secured. This I have observed repeatedly in transverse dorsal 
myelitis ; compression-myelitis, when due to Pott*s disease, also offers 
relatively favorable chances ; even in multiple sclerosis I was sometimes 
forced to attribute intermissions, in part, to the favorable action of elec- 
trical treatment. 

The condition of the electrical excitability varies greatly according to 
the character of the lesion. In a large majority of the cases it remains 
normal ; in isolated cases I noticed distinct increase of the faradic and 
galvanic excitability of the nerves in the paraplegic limbs; more fre- 
quently there is slight quantitative diminution of irritability ; not at all in- 
frequently partial or complete De B was observed when the anterior gray 
horns of the cervical or lumbar enlargements were implicated. 

The electrical current con only act in these forms of disease by means 
of its catalytic effects, and direct application of the galvanic current to the 
site of disease is therefore indicated. Various methods are suitable ; in 
circumscribed foci of disease, the stabile and successive application of 
both poles with a moderate strength of current and not too long duration 
(one to five minutes) ; in more diffuse or funicular affections, longitudinal 
conduction with successive change of the points of application, perhaps 
also an application to the cervical sympathetic. When painful points are 
present, the An is to be applied stabile. In compression-myelitis with 
kyphosis, the electrodes should be placed above and below the latter. In 
addition, symptomatic treatment of the most important disturbances of 
function is indicated. 

In multiple sclerosis applications must be made to the brain according 
to the methods previously indicated. 

6. In tabes dorsalis the application of the electrical current constitutes 
one of the most important measures of treatment The results obtained 
in this disease are not brilliant ; recovery, or a condition bordering on re- 
covery, occurs in but a very small percentage of cases, and in a large 
proportion our efforts are entirely useless. 

A therapeutic trial alone can decide whether the prognosis wiU be 
favorable or imfavorable ; but so much less can be expected from treat- 
ment the more advanced the progress of the disease. At present we can 
make a diagnosis in the earliest stages from a series of very important in- 



174 ELEOTRO-THEEAPEUnOS. 

itial symptomB (lancinating pains, parBesihesia, tired feeling in the legs, 
absence of tendon reflexes, reflex rigidity of the pupils, analgesia and slow* 
uess of conduction of pain, tottering on closure of the lids, paralysis of 
ocular muscles, weakness of the bladder and sexual power, etc.), so that 
most patients have a chance of the earliest possible treatment 

In many cases of tabes I have found the electrical excitability entirelj 
normaL In a series of cases I noticed slight increase of the &radic and 
galvanic irritability of the peroneal nerves (especially at a relatively early 
stage) ; in another series, moderate diminution of irritability in these 
nerves. Qualitative changes of the law of contraction occur veiy rarefy 
in the nerves {vide Lecture X., page 91). 

The most important feature in treatment is the direct application of the 
galvanic current to the spinal cord. The methods employed by various 
authors differ very little from one another. I usually employ the method 
described above (page 169) of application to the spinal cord and the cervi- 
cal sympathetic, and I have every reason to be satisfied with this plan. 
The application should last from three to five minutes ; the strength of 
the current should be very carefully chosen ; sittings daily, usually for a 
number of months. 

With this central treatment you may associate peripheral galvanization 
of the nerves of the lower limbs (Ca labile, An on the lumbar spine) ; 
faradization is also praised by many patients. 

Next comes the symptomatic peripheral treatment of the various phe- 
nomena of tabes (paralysis of octdor muscles, atrophy of the optic nerves, 
ansesthesia, etc. ), according to the methods which will be described here* 
after. The lancinating pains are sometimes relieved by various proced* 
TU'es, such as stabile application of the An to the spine at the point of 
origin of the affected nerves ; stabile application of the Ca on tlie painful 
and hypencsthetic portions of integument (the An upon the roots of the 
nerves) ; increasing faradic current to the same region, etc. 

Two other methods merit a trial in suitable cases. One is the treat- 
ment of galvanic pressure or painful points by the stabile application of 
the An. At first the painful points and the girdling pains associated with 
them disappear and an improvement of all the other symptoms usually 
follows. Unfortunately, these painful points are extremely rare. 

The other method is the application of the farado-cutaneous brush, 
which has been repeatedly recommended by Rumpf. This procedure con- 
sists of vigorous faradic brushing of the integument of the trunk and 
limbs for about ten minutes, either daily or every other day. Bumpf 
recommends this plan for those cases alone in which paii^s and parsBstheaiffi 
still constitute the most prominent part of the 83rmptomatology. 

7. In q)a8tic spinal paralysis when due, as pure cases probably are, to 
funicular degeneration of the pyramidal tracts, the same galvanic treatment 
is indicated as in tabes dorsalis. 



SPECIAL ELSCTBO/THBRAPEXTnOS. 175 



Hie deetrical irritability in this disease presents no anomalies, or, at 
a slight diminution of the faradio and galvanic excitability. 

If you are in doubt with regard to the diagnosis and surmise that the 
symptoms may be due to a beginning dorsal myelitis or the beginning of a 
multiple sderosis, or, as is not so very infrequent in children, an affection 
cl the brain (chronic hydrocephalus), the electrical treatment suitable to 
these forms of disease should be instituted. 

I have repeatedly obtained very &vorable results in cases of spastio 
qpinal paralysis. 

8. All electro-therapeutists are agreed that acute, anterior poU<miyelUi» 
(infantile spinal paralysis) is a suitable object for electrical treatment 
This term refers to acutely developing forms of paralysis with rapid degen- 
erative atrophy and De B, without sensory or bladder disturbance, etc., in 
winch the paralysis reaches its acme at the onset and then recovers in part ; 
the paralysis is due to an acute inflammatory process in the anterior horns 
<d gray matter, affecting by preference the cervical and lumber enlarge- 
ments. 

The conditions of electrical excitability in this disease are of no slight 
diagnostic and prognostic importance. The De B must be regarded as a 
oooiBtant phenomenon in this affection ; as a rule it is complete, but in 
some muscles and nerves it is only partial 

A careful examination is attended generally with very great difficulty, 
at le :st in little children. There is certainly no more ungrateful object of 
electrical examination than these little crying and strug^ng patients, who 
dread such manipulation extremely on account of the retention of sensibil- 
ity, and in whom the localization of the current and the recognition of the 
effiaets to be obtained are rendered still more difficult by the abundant 
pomiculus adiposua Not infrequently the patients come under observa* 
tion at a late stage, when even the galvanic excitability has been low- 
ered markedly, and the determination of the result is rendered more diffi- 
oalt in this manner. In the majority of cases, accordingly, we must confine 
oaxselves to a superficial recognition of the De B, obtained by a few clos- 
ures or changes of polarity of the galvanic current, and with a short fara- 
dio examination of the nerve-trunks. The slowness of the contractions 
and the predominance of An Cl C are particularly characteristic. In recent 
oases, however, in which exaggeration of galvanic excitability still persists, 
and in adults, the recognition of De B does not present the slightest 
difficulty. 

As a rule, complete De B is found in the majority of neuromuscular 
tracts ; partial De B may be present in some of these tracts, but this does 
not occur very often. Whether De B may be entirely absent in certain 
mild cases (the so-called *' temporary " forms of infantile paralysis) in all 
the affiBcted groups of muscles, does not appear to me to be settled defi- 
nitely, but it seems quite possible. 



176 BLEOTBO-THEKAPEUnOS. 

In those muscles which are partially restored, the phenomena of the 
De R disappear ; after the disease has lasted for a long time, the markedly 
atrophied muscles become almost absolutely inexcitable. 

The indications and methods of application of the electrical current 
are very simple and precise ; we have to deal with sharply localized, small 
foci of inflammation and their residua, and with a degenerative atrophy of 
the peripboral motor-nerves and muscles, similar to that occurring in every 
severe traumatic paralysis. But eicperience has shown that the prognosis 
with regard to complete recovery is almost always bad. Only in the mild, 
temporary forms will rapid or complete recovery be secured ; in the ordi- 
nary severe forms we can, at the most, restore the function of the slightly 
affected muscles, the others can be improved to but a slight extent. In 
not a few cases, however, persistent treatment may serve to strengthen 
individual muscles, and thus perhaps be of great advantage to the 
patient. 

The earlier the treatment is begun, the greater the chance of saving 
what is not yet irretrievably lost, and it should therefore be instituted as 
soon as the acute inflammatory stage has subsided. 

The direct treatment of the morbid process is the most important ; 
the galvanic current should be employed with stabile action upon the cer- 
vical or lumbar enlargements, or on both. The site of disease is covered 
with a " large " electrode, the other being applied to the anterior surfetce of 
the trunk or other indifferent spot (first the An, then the Ca), for one or 
two minutes with a moderate strength of current (15® to 40^ N. Del, 150 
C B). If both enlargements are implicated, one pole is applied over each, 
and the current allowed to pass first in one, then in the other direction. 

In addition, the paralyzed neuro-muscular tract should be galvanized 
peripherally with the Ca labile, the An being placed over the site of dis- 
ease ; in the later stages, it will be necessary to employ cathodal dosurea 
and changes of polarity with a considerable strength of current. 

Frequently it is only after protracted treatment that slight, slow,^ mus- 
cular contractions again make their appearance. The object of this form 
of treatment is to antagonize the degenerative atrophy and preserve the 
muscles imtil voluntary conduction is again possible. This object is often 
achieved very imperfectiy, though sometimes in a surprising manner. 
You should, therefore, not be dismayed by the labor and time which must 
be expended upon the peripheral treatment. 

The entire treatment must be continued for a very long time ; if begun 
very early, it should be kept up constantiy from six months to a year. In 
older cases, it is sufficient to use galvanism about twice a year for two to 
three months at a time (forty to sixty sittings) and to employ other meas- 
ures (baths, massage, gymnastics, etc.) during the intervals. 

A certain amount of success has also been obtained from the use of the 
faradic current, applied peripherally to the paralyzed muscles. Beliable 



SPECIAL ELECTRO-THERAPEUTICS. 177 

authorities have even reported succeBsfol results from its applicaticm to 
muscles which exhibit complete De B. 

This cannot be accounted for on the theory of a peripheral irritatioa 
of the trophic paths ; it is more probable that a reflex influence is exerted 
upon the site of disease, the centripetal sensory paths being entirely intaot 

9. Subacute and chronic anterior poliomyelitis^ in its various forms, 
presents a much more favorable prognosis. This form of disease is char- 
actemed by a more or less rapid, and for a time, progressive atropbio 
paralysis, usually in a paraplegic form, without disturbance of sensation, 
the sphincters, or the cerebral nerves, — a flaccid paralysis with rapid de- 
generative atrophy of the muscles and partial or complete De R Its 
course is usually favorable ; it soon comes to a stand-still, and the para^- 
sis not infrequently recovers completely. It is undoubtedly due to a 
nutritive (inflammatory ?) disturbance of the anterior gray columns, but 
which evidently does not possess the destructive character of acute an- 
terior poliomyelitis. 

Electrical examination in this disease reveals the presence of the De B 
in all possible stages of development. With the recovery of the disease, 
the electrical excitability slowly returns to the normaL 

The electrical treatment consists of the application of the galvanic eor- 
rent to the spine according to the methods previously described. 

As the enlargements are the usual site of the disease, these should be 
specially subjected to the action of both poles in succession, with stabile 
currents of sufficient strength. In addition, peripheral treatment of the 
paralyzed and atrophied neuro-muscular tracts with the labile Ca, changes 
of polarity, etc., according to the circumstances of the case. The faradic 
current may usually be dispensed with in this disease, though it may be 
employed for peripheral irritation of the nerves and muscles in partial De B. 

The results are generally satisfactory. I have repeatedly observed aa 
immediate beneficial effect from the use of the current, and, as a rule, the 
improvement is very distinct after a short course of treatment (mde Ob- 
servations 33 and 34). The number of cases hitherto treated is still too 
small to permit us to decide when it is best to begin treatment ; a 
priori^ I should say as early as possible, except in febrile cases, in which 
it is undoubtedly better to wait until the fever has subsided. 

10. Progressive muscular atrophy, which may be regarded as a dissem- 
inated, progressive degeneration of the gray anterior horns, is character- 
ized by a progressive, slowly spreadinjr, degenerative atrophy of a large 
part of the voluntary muscles, with fibrillary twitchings, followed later by 
paralysis and disappearance of the muscles, without distiu'bance of sensa- 
tion, the sphincters, brain, and cerebral nerves ; not infrequently it is 
finally combined with progressive bulbar paralysis. 

The electrical examination is very important in making a differential 

diagnosia At the onset of the disease there is generally no distinct 
12 



178 ELECTBO-THEBAPEUnOS. 

anomaly and even after its long continuance many nerves and moacles 
merely present simple diminution of faradic and galvanic excitability cor- 
responding to the degree of atrophy. As the degeneration prc^esses, 
however, indications of the De R make their appearance in certain muscles^ 
and gradually become more distinct 

At first we find merely a partial De B, ue., the faradic irritability is di- 
minished but not extinguished, while the galvanic excitability of the 
muscles is affected in the characteristic manner, i.e., delay in the contrac- 
tion, predominance of the An CI C, but usually great diminution of irrita- 
bility ; at a later stage, complete De B is observed. This change is usually 
found in the small muscles of the hand, but occasionally in others ; I must 
insist upon my view that De B occurs uniformly in all cases of progressive 
muscular atrophy. In many cases, however, it is not readily demon- 
strable and requires very careful examination and great skill in the recog- 
nition of the De R This is due to the anatomical peculiarity of the dis- 
ease, inasmuch as a number of healthy fibres are always found alongside 
the degenerated ones, and, the irritability of the motor nerves being re- 
tained, the qualitative changes may be concealed by the contractions of the 
healthy fibres. In the examination you must, therefore, employ all those 
devices to which I have previously called attention {pB,ge 87). 

In one form of progressive muscular atrophy, viz., that beginning in 
childhood and youth (juvenile form), I have never observed the degeneration 
reaction, but merely a simple diminution of faradic and galvanic excita- 
bility corresponding to the degree of atrophy. I regard this variety of 
the disease as distinct from the typical form. 

Electricity has always been recognized as the most important if not the 
sole means of treatment in progressive muscular atrophy. In its typical 
form, however, this disease may be regarded as incurable ; the reports of 
recoveries from the affection probably depend upon errors in diagnosis. 
In a few cases I have obtained improvement, even a temporary stand-still 
of the affection. The ''juvenile form," referred to above, offers a much 
better prognosis. 

In accordance with our views regarding the nature of the disease, gal- 
vanization of the spinal cord must play the chief part in the electrical 
treatment. The sympathetic may also be included in the treatment, es- 
pecially when the disease is located in the cervical portion of the cord. 
The localization of the atrophy in the various groups of muscles furnishes 
us with accurate data concerning the site of the disease in the spinal cord, 
and the electrical treatment consists essentially of the stabile application 
of both poles with moderately strong currents to the diseased parts of the 
cord. In addition, moderately strong galvanization or faradization of the 
neuro-muscular tracts which are chiefly affected (Ga labile. An over 
the site of the disease). In peripheral applications you should avoid too 
strong currents, as excessive irritation might hasten the degenerative pro- 



SPECIAL ELECTRO-THERAPEUTICS. 179 

in the masdea This point can be determined ordinarily by the 
condition of the patient after each sitting. The treatment should be con- 
tinued until its uselessness has been demonstrated. 

The galvanic treatment of amyotrophic lateral sclerosis, which possesses 
an undoubted relationship to progressive muscular atrophy and is char- 
acterized by simultaneous sclerosis of the pyramidal tracts (symptoms of 
spastic spinal paralysis) should be conducted essentially according to the 
same principles, especial consideration being paid to the funicular degen- 
eration which requires an action upon the entire cord. In this disease 
partial De B is observed more or less distinctly in the upper atrophic ex- 
tremities, but there is no noteworthy change in the lower paretic and 
non-atrophied limbs. The prognosis of this affection appears to be as un- 
favorable as that of progressive muscular atrophy. 

11. In acute ascending paralysis, a form of disease which has not yet 
been defined with precision either clinically or anatomically, very favor- 
able effects frpm the use of electricity have been observed during the stage 
of convalescence. It is said to be characteristic of this disease, at least in 
typical cases, that the electrical irritability remains perfectly intact, but 
its relations to the ascending form of subacute anterior poliomyelitis still 
remain to be definitely ascertained. 

It is a question whether the electrical current should not be employed 
even in the early stages of the disease, while it is still progressive ; a 
priori, this seems to me to be justifiable. I would recommend the appli- 
cation of moderately strong stabile currents along the entire spinal 
column for three to five minutes, either daily or even twice a day. 

12. Secondary degenerations of the spinal cord have rarely been sub- 
jected to electrical treatment Indeed, very little can be hoped for if the 
primary disecise persists. There can be very little question of treatment 
of ascending secondary degenerations, since they can not be diagnosticated 
because they do not produce any symptoms to our knowledge. 

This does not hold good, however, of the descending secondary degener^ 
aiions of the pyramidal tracts, especially in cerebral diseases (hemorrhages, 
softening, etc). It is generally assumed that this degeneration exerts a 
certain influence upon the symptomatology, giving rise to an exaggeration 
of the tendon reflexes and the later paralytic contractures in the paralyzed 
parts ; the latter often offer an obstacle to the return of mobility. Re- 
lief of the secondary degeneration may benefit the patient, accordingly, in 
certain cases, especially when the primary disease has improved. In such 
an event the galvanic current may be recommended. The method which 
may be employed is the same as in all systemic degenerations of the 
cord ; the stabile protracted appHcation of the An to the entire spine, the 
Oa being placed over the cervical sympathetic ; in older cases this may be 
followed by the appUcation of the Ca to the spine. 



\ 



m. DISEASES OP THE PERIPHERAL NERVEa 



LECTURE XX. 

Ibtrodaction— Availftble Current Effects in Dieeaees of the Periphoal Nenree— Pne- 
tioal Experienoe: Cases — Technique and Methods of Electrical Treatment — In- 
dividuul Forms of Disease : Neuritis ; Hemorrhages and Ciroolatorj Dieordexs ; 
Blight Mechanical and Traumatic Leaions ; Severe Traumatic Lesions ; Degener- 
ative Atrophy of the Nerves ; Functional Disorders — Symptomatic Treatment — 
Blectro-diagnostio Remarks. 

I WILL now turn to the consideration of the anatomical lesione and 
diseases of the peripheral nerves, apart from their individual eymptoniB, 
such as spasm or paralysis, neuralgia or anaesthesia, eta Concerning the 
molecular nutritive disturbances which are frequent causes of disordered 
function, and give rise especially to neuralgia, spasms, perhaps also paral- 
ysis, we can only speak in passing. 

We have to deal here with very few morbid processes, viz., sub acute 
and chronic forms of neuritis, next the rare circulatory disorders, antemia 
and hypersemia, and the much rarer hemorrhages into the nerves. Then 
we have to deal with the mechanical and traumatic lesions of the nerves, 
in all their varying degrees of severity, and finally with degenerative 
atrophy, which is usually secondary, but occasionally, perhaps^ occurs 
primarily in the form of chronic parenchymatous neuritia 

If you bear in mind our previous discussions, you will readily see that 
any favorable effect of electricity in these various affections of the pe- 
ripheral nerves must depend mainly upon its catalytic actions, upon its 
effects on circulation and nutrition, upon inflammation and its conse- 
quences ; to this category belong also the effects upon cicatricial tissue, 
upon cirrhosis and degeneration, the absorption of extravasations and ex- 
. udations into the nerves and nerve-sheaths, finally the effects upon the 
molecular or nutritive disturbances produced by pressure of short duration 
or by moderat^ compression ; the catalytic action of the current may be 
of service in all these conditions. 

The vasomotor effects of the current are also undoubtedly beneficial in 
hyper.Tmia and ansemia of the nerves, or when it is necessary to stimulate 
nutrition or combat degenerative atrophy. The stimulating and modify- 



SPECIAL ELEOTRO-THBBAPEUnOS. 181 

ing actions of the cuirent may, perhaps, be useful in relieTing local nuiri* 
tive disturbance& 

The following series of cases will serve to illustrate the effects of elec- 
trical treatment : 

36. Personal observaiion. Chronic neuritis of the median nerve, — ^A 
woman, aged forty year& Suffered for a year and a quarter from neuritis of 
the median nerve above the right wrist. It began with numbness in the first 
four fingers, then pains in this region, which increased until they prevented 
sleep. The median nerve above the wrist is felt as a thickened, spindle- 
shaped band, which is tender on pressure ; this also causes pain and for- 
mication in the entire distribution of the nerve ; the latter presents trophic 
disturbances of the skin. The pain is localized, burning, continuous, but 
occasionally exacerbating ; no anaesthesia ; the hand grows tired very 
easily. Faradic and galvanic excitabiUty of the nerve somewhat in- 
creased. G^vanic treatment An stabile upon the nerve above the vmst 
and in the fold of the elbow. Considerable improvement after the second 
sitting. After the tenth sitting, the patient slept the entire night ; feeling 
in the hand much more normsd ; pain much lessened. The swelling of 
the nerve constantly diminished. Complete recovery in all respects after 
seventy sittings. 

37. P^monal observation. Chronic neuritis nodosa (neuroma f) of the 
ulnar nerve, —An engineer, aged twenty-five years. Had a dislocation of 
the right elbow twenty years previously, leaving sUght deformity, but 
complete usefulness. Had formication in the httle finger of the right hand 
for eight years after protracted vnriting or drawing (mechanical irritation 
of the ulnar nerve by the dislocated internal condyle). For two years, 
weakness and wasting of some of the small muscles of the hand ; for a year, 
constant feeling of numbness in the little finger and a deep-seated pam in 
the fourth finger. *Status : the hypothenar eminence of the right hand, the 
adductor polUcis and most of the interossei completely paralyzed and atro- 
phic ; other muscles normal. Complete De B in the paralyzed muscles. 
SensibiUty in the ulnar distribution somewhat diminished. At the elbow- 
joint the uhiar nerve presents a distinct, spindle-shaped thickening, about 
as large as a bean. Gialvanic treatment : An stabile upon this swelling, the 
Ca alternately above and below it ; a few changes of polarity ; then labile 
appUoation of the Ca to the distribution of the ulnar nerve (An upon the 
swelling). After fifteen sittings, constant and progressive improvement ; 
the movements of the hypothenar eminence, adductor brevis pollicis, and 
most interossei (with the exception of that of the fourth finger) have re- 
tumed. Return of the faradic irritabiUty of the ulnar nerve above the 
vmst, but not of the muscles. Feeling of numbness markedly dimin- 
ished ; enlargement of the ulnar unchanged. Patient is discharged. Im- 
provement occurred later. 

38. Personal observation. Neuritis of the brachial plexus ; combined 
shoulder-arm paralysis (Erb). — A man, aged fifty-two years. Taken sick five 
weeks ago with pain and stififhess in the back of the neck, then had pain 
in dioulder and arm, with parsesthesia in the thumb and index finger ; pro- 
gressive paralysis of the arm. Examination shows complete paralysis 
and marked atrophy of deltoid, biceps, bi*achiaUs intemus, and supinator 
longus ; supinator brevis also appears to be weak. Tactile sensation some- 
what blunted on thumb and index finger. A few tender spots in left 






182 ELECTRO-THEBAPEUTIOS. 



Bupra-clavicular fossa. Electrical irritabilitj slightly diminished. Qal- 
vanic treatment: An stabile to brachial plexus, galvanization of i^mpa- ! 

thetic and descending labile through the paralyzed muscles and nerves. 
Complete recovery after thirty-five sittings. 

39. Observation by B. Remak, Faralyids of the deltoid ; neuritis of the 
brachial plexus. — A man, aged thirty-one years. Bheumatism of the three 
large joints of right arm for three months ; two months ago, sudden com- 
plete paralysis of right deltoid, which resisted aU therapeutic measures 
(faradization, blisters). Distinct, tender sweUing of the brachial plexus^ 
especially of that part from which the circimiilex arises. No immediate 
efiect from labile application of Ca to the muscle. Stabile application of 
An (two to three minutes) to the painful part of the plexus enables the 
patient at once to raise the arm to the vertical ; the swelling then appeared 
less painful. Two further applications of the current completed the recoveiy. 

40. Personal observation. Traumatic paralysis of the left arm (from dis- 
location of the shoulder). — A man, aged sixty-three years. October 23, 
1869, dislocation of left shoulder ; immediate paralysis of arm ; marked 
anaesthesia of arm at first, which is now somewhat improved. 

February 23, 1870. — Complete paralysis of left forearm and hand ; 
triceps almost completely paralyzed, biceps and brachiolis intemus nor^ 
mal. Complete De R in paralyzed musclea Sensibility diminished in 
hand and radial side of forearm. Galvanic treatment : An stabile through 
the shoulder-joint, then Ca labile through the nerves and musdea 

March 3d. — While the Ca is in a:ulla, a slight voluntary contraction 
occurs in the flexor muscles of forearm. 

March 29th. — While An is stabile in the axilla, a slight movement oc- 
curs in extensor muscles of forearm, and traces of contraction on attempt- 
ing to contract these muscles voluntarily ; their power of motion increases 
perceptibly during the next few days. The arm and hand, which had 
been swollen, bluish red, and cold, look much better. 

April 6th. — Patient discontinues treatment ; markedly improved. 

June. — The improvement has advanced still further. 

41. Personal observation. Paralysis of the right radial nerve (weuritw f 
trauma?). — A man, aged forty-five years. December 26, 1874, sudden 
paralysis of right radial nerve, with formication in its distribution to the 
nand ; 6u*adization useless. 

Status on February 15, 1875 : Paralysis of entire radial distribution in 
forearm ; sensibility unaffected. Electrical examination proves the site of 
the lesion to be in the region where the nerve bends around the elbow (in- 
terruption of conduction) ; below this locality the distribution of the 
nerve presents partial De R ; no contraction can be obtained through the 
nerve above this point Galvanic treatment : An in the neck, Ca stabOe 
over the site of the lesion (with a few changes of polarity), then labile 
through the nerve and muscles. Considerable improvement after the 
fourth sitting, especially in the supinator longus, extensores radialis and 
digitorum. Complete recovery after twenty-two sittings ; electrical irri- 
tability nearly normal. 

42. Observation by Mor. Meyer. Neuralgia (neuritis f) of the brachial 
plexus. — A girl, aged fourteen years. Pain for nine months in fourth in- 
terosseous space of right hand, which gradually extended over arm and 
forearm in the course of the radial nerve ; a small, thickened, painful spot 
in outer part of brachial plexus. Immediate relief from stabile application 
of An to this spot ; recovery after seventeen sittings. 



SPECIAL ELECTRO-THBBAPEUnCS. 183 

43. Observation by Mor, Meyer, Neuralgia (neuritis f) of the ulnar nerve, 
— ^A girl, aged nineteen years. Pain for three years in fourth right meta- 
carpal space and along the course of the cutaneous branch of tlie ulnar 
nerve to the elbow and to the right side of the neck ; inability to use the 
arm. Great tenderness of lower part of brachial plexua Application of 
An to this region produced considerable improvement after four sittings ; 
not completely cured until fifty-four sittings. 

44 Personal chservation. Right occipital and trigeminal neuralgia (neu- 
ritis f), — A compositor, aged twenty-four years. April, 1872, severe supra- 
orbital and infraorbital neuralgia cured by four applications of An stabile. 

June, 1872. — Neuralgia of both trigemini and occipitalis cured in a 
few days by An stabile. 

August, 1873. — For two weeks has had pain in right ear, right side of 
face, and right half of occiput and scalp ; feeling of numbness in these 
parts. No painful point in the face, but one in the course of the occipi- 
talis major nerVe. Moderate anaesthesia throughout the painful region. 
Gbdvanic treatment : An stabile in front of thc^ ear and on the occiput, the 
current being gradually increased and decreased. Cured in ten sittings. 

46. Personal obser vol ion. Left sciatica ; anceathesia (neuritis?). — A por- 
ter, aged forty-three years. Four weeks ago had severe pain in the back, 
which disappeared after some vapor baths ; then very violent pains for 
two weeks in left thigh and foot ; was then free from pain for a week, but 
had feeling of numbness throughout the left leg in the distribution of the 
sciatic, with weakness of the limb. Status: dragging gait; leg very 
weak ; sensibility diminished in sciatic distribution ; marked feeling of 
coldness in the limb, which also feels colder than its fellow. Oalvanic 
treatment : Descending stabile current, with a few closurea After fifteen 
sittings : pain and numbness entirely disappeared ; sensibility also normal 
objectively. Discharged cured, and has remained so since. 

46. Personal observation. Right supraorbital neuralgia, — ^A glove maker, 
aged twenty-six years. For five days past, violent neuralgic pains in right 
supraorbital nerve ; relief at night ; very marked point douloureux at the 
supraorbital foramen, nerve sensitive to pressure throughout its entire 
extent No sensory disturbance. Galvanic treatment : 8 elements gradu- 
ally increased and diminished. An stabile upon the nerve-trunk, Ca upon 
the left hand ; pain disappeared immediately afterward. Cured after 
two more sittings. Painful point had disappeared after first sitting. 

47. Personal observation. Neuralgia of the superficial branch of the left 
radial nerve. — A servant, aged thirty-three yeara Has suffered for a week 
from the most violent pains in the distribution of and along the left 
superficial radial nerve, beginning at 4 p.m. and lasting during the entire 
night. Movements of the hand and fingers performed with difficulty 
daring the paroxysms. For six days, numbness in distribution of nerve 
to the hand. Painful point upon the nerve. Galvanic treatment: de- 
scending current, stabile through the nerves, three to four minutes. The 
pain did not return after the first sitting ; merely shght twinges, which 
disappeared after two more sittings. 

48. Personal observation. Trigeminal neuralgia ; herpes Idbialis. — A 
servant, aged twenty-four years. Sick for past three days with vomiting, 
headache and some fever ; since yesterday very violent pain in left half of 
face. Painful points at the supraorbital and infraorbital foramina. Her- 
pes of the left lower lip. 

March 2l8t — Galvanic treatment ; stabile from the mastoid fossa io 



} 



184 KLECTEO-THEBAPEUTICS. 

the Bnpraorbital, infraorbital, and mental foramina ; a few dosures of the 
current Great relief experienced immediately. 

March 26th. — Discharged cured. 

49. Observation by Leber, Retrobulbar optic neuritis. — ^A boy, a^ed 
nineteen years. The disease has continued unchanged for eight months 
despite all treatment ; then striking and very rapid improvement and 
almost complete restoration in one eye during galvanization of the sym- 
pathetic (An over the superior ganglion), while transverse conduction of 
the current through the temples had proven fruitless. An improvement 
in sight could be noticed after each sitting. 

60. Observation by Donald Fraiser. While atrophy of the optic nerve. — 
A man, aged fifty-nine years. Diminution of vision for past five yeara 

September, 1871. — Right eye Sn 20 at four inches, lefft eye at eight 
inche& Ophthalmoscopic examination : the external two-thirds of the 
optic nerve white and shining, the inner third congested ; the veins tor- 
tuous and wide, the arteries diminished in number and calibre ; white 
streaks along some of the vessela Diagnosis : primary degeneration of 
the optic nerve. Treated unsuccessfully for a month with mercury and 
iodine. 

October, 1871. — Sn 20 with both eves at seven and a half inches. 
Galvanization with 6 elements through the temples for twenty seconds ; 
immediately afterward, Sn 20 at ten inches. Treatment : longitudinal 
and transverse conduction of the current through the head. Progressive 
improvement at the end of three months, Sn 5j^ seen as readily as Sn 20 
at the beginning. 

January, 1872. — Distinct improvement also in the ophthalmoscopic ap- 
pearances, the arteries wider, the veins narrower and less tortuous. The 
improvement makes still further progress. 

As in diseases of the brain and spinal cord, so in those of the periph- 
eral nerves, we must rely almost exclusively for the production of cata- 
lytic and vasomotor effects upon the galvanic current ; the faradic cur- 
rent may perhaps be available, like the galvanic, in the production of 
stimulating and modifying effects, and to relieve molecular, nutritive dis- 
turbimces. 

In the majority of cases we must apply treatment as directly a9 possi- 
ble to the diseased part, though an indirect effect cannot be excluded, in- 
asmuch as it is possible to set in action vasomotor and even trophic influ- 
ences from pai'ts of the nerve situated superiorly or from the sympathetic 
system (cervical sympathetic in optic neuritis) or even from the spinal 
cord and its centres ; and finally a refiex action from the skin (foradic 
brush, etc.) may not be useless, especially in functional, molecular changes 
(for example, in neuralgia). 

The following methods of application may be employed in the special 
forms of disease of the peripheral nerves : 

In neuritis, at least in more recent cases, the most favorable effect is 
obtained from the stabile application of the An, the Ca being placed either 
directly opposite or upon some indifferent spot (sternum) ; it appears to 
ma more advisable to place the Ca upon a more central portion of the af- 



SPECIAL ELECTBO-TnBBAPEUnO& 18& 

feeted nerve or upon the corresponding portion of the spinal cord in order 
to a£fect the vasomotor (and trophic?) nerves. Moderately strong car- 
rents (25'^ to 40"" deflection of the needle with 150 C B) are employed and 
allowed to act from two to ten minates according to circumstances. In 
older, mcMre chronic cases (vide Observation 37), in which induration and 
cirrhosis with advanced degenerative atrophy are present, the An is used 
alternately vnth the Ca, the latter perhaps to a greater extent and virith 
greater intensity. The same methods may be employed in hemorrhages 
into the nerve-sheaths, which occur and are recognized with equal in- 
freqoency. 

In mild mechanical and traumatic lesions it has been ascertained with 
certainty that the direct application of the galvanic current to the site of 
lesion is useful, and that distinct improvement sometimes occurs imme- 
diately after its employment. This favorable effect is e8X>ecially secured 
by the stabile application of the Ga of a feeble galvanic current An indi- 
rect vasomotor or catalytic effect may also be sought for by galvanizing 
the central portion of the nerve. Moderate faradic currents are also ad- 
missible for the same purpose, and may also be useful in a reflex manner 
(faradic brush). 

In severe traumatic lesions a favorable effect from the electrical cur- 
rent can only be looked for when the cause is removed ; in part this may 
be done by the absorbing, catalytic action of the current itself (in cicatri- 
cial formations, incised woimds and the like), but the treatment of the 
cicatrix of the nerve, the furtherance of the union of both ends of the 
divided nerve do not appear to be entirely useless. The site of the lesion 
must then be treated vigorously and for a long time with stabile currents, 
the An and Oa being applied successively ; in older cases, the Ca stabile 
and labile should be also applied to the central end of the nerve. 

The degenerative atrophy of the nerves must also be treated forthwith 
in such cases. Experience teaches, however, that there is no hope of suc- 
cess unless central trophic influences are not entirely excluded or haTe 
been restored to a certain extent, since the development of degenerative 
atrophy cannot be prevented. Beal success can be expected in such cases 
alone in which the original lesion of the nerve has been so far relieved 
that some connection has been restored between the peripheral and cen- 
tral portions of the nerve. In all such cases of secondary degenerative 
atrophy (recognizable by the De R), treatment of the site of the lesion is 
the most important, that of the degenerative atrophy merely secondary. 
When we have to deal vrith primary degenerative atrophy (so-called par- 
enchymatouB chronic neuritis), its treatment is the most important. 

In bbth events, it is our object to hasten the regeneration of the nerve- 
fibres The most suitable method is vigorous galvanization of the nerve- 
trunk throughout its entire extent : I first apply the An stabile, then 
chiefly the Ca, passing it labile along the nerve-trunk ; moderately strong 



186 BLEOTBO-THEBAPEUnOS. 

corrent for one to four minutes daily along each nerve. The same method 
is employed upon the muscles supplied by the diseased nervea 

As soon as practicable — forthwith in the primaiy forms, and as soon 
as we suspect the restoration of trophic conduction in the secondarr 
forms — it is well to treat also the central portion of the nerve or the cor- 
responding centres in the spinal cord, in order to hasten the healing pro- 
cess in the peripheral part by stimulation of the vasomotor and trophie 
paths and centimes. 

The choice of currents in the treatment of purely functional disorders 
of the peripheral nerves (neuralgia, anesthesia, spasms, certain paralyses, 
etc.), will depend upon the indications present^ and these will be diseaaBed 
in the subsequent lecture& 



Yery few remarks are necessary with regard to electrical irritabiliij in 
lesions of the peripheral nerves. The electrical examination is very im- 
portant with regard to the localization of the lesion, when the position at 
which conduction is interrupted can be ascertained. If the irritability of 
a motor nerve is retained below the site of the lesion, but is lost above 
this point, the exact location of the morbid process is readily ascertained, 
as it is also when, in a sensory nerve, no eccentric sensations can be pro- 
duced below a certain spot, but are preserved above it 

All possible changes of electrical irritability may occur, as you will 
member from our previous remarks on general electro-diagnosia 



IV. PARALYSIS AND ATROPHY. 



LECTDKE XXI. 

Deflnition and PathogenesiB of Paralysis— Objects of Eleotro-therapentios in Paraljiis 
and the Methods of Effecting them : a. Removal of the Gaose of Paralysis — 
b, Bemoval of Obstructions to Motor Gondaction ; Direct and Indirect Method ; 
Utilization of Retiex Paths ; Method of Application of the Faradio and Galvanio 
Gunents for these Parposes— <;. Belief of Finer or Grosser Kntritiye Disturbancea 
in the Motor Gondacting Paths — d. Bestoratiou of the Normal Gondition of the 
Paralyied Muscles — Treatment of Muscular Atrophy— Results of Electro-thera- 
peutics in Paralysis — Electro-diagnosis of Paralyses — Practical Technioal 
Remarks. 

Pabaltsis may be defined as " a diminution or extinction of the power 
of stimulating the motor nerves and muscles to their normal functions." 

This condition may be produced bj disease of the muscles themselyes 
(atrophy, degeneration, diminished irritability from certain poisons, etc.), 
and then constitutes so-called myopathic paralysia Or paralysis may be 
due to disease of the motor tracts at any part of their course from the 
musdea to the motor centres of the cerebral cortex and to disease of the 
latter centres themselyes ; this is neuropathic paralysia 

The latter form may be due to various causes which impair the func- 
tion of the ganglion cells and nerve-fibres, viz. : inflammation, degenera- 
tion and atrophy, hemorrhage, anaemia and hypersBmia, perhaps most 
frequently to simple mechanical actions, such as compression, rupture, 
division, etc ; in addition, to less palpable, not gross, anatomical changes^ 
such as the action of certain poisons, exhaustion, exposure, hysteria, etc. 
— ^in shorty to so-called " functional" disturbances of whose material basis 
we are yet ignorant. 

This does not exhaust all the phenomena occurring in paralysis and 
which are occasionally the subject of our therapeutical eflforts. Certain 
changes and sequeles may develop in the paralyzed parts, the nerves and 
muscles ; they are frequently of a simple, nutritive, molecular character, 
and are manifested by diminished power of conduction and excitability — at 
most by simple wasting. They are due in part to disuse, in part to the 
absence of certain trophic stimulations. Not infrequently, however, these 
disturbances are of a much more serious character, constituting degeneia- 



188 BLBOTRO-THEBAPEUTICS. 

Hve atrophy of the nerves and muscles and advancing to marked fibzoos 
cirrhosis. 

The object of electrical treatment in all these pathological prooessea is 
the restoration of the normal influence of the will upon the muscles, t.e., 
in the large majority of cases, the restoration of conduction in the motor 
nei*ye-tracts ; in a smaller number of cases, the restoration of the irrita- 
bility, contractile power, and nutrition of the muscles ; in almost all cases, 
in addition, we are required to relieve the changes in the nerves and mus-' 
des consequent upon the paralysis. 

0. Our most important object is the removal of the cause of paralysis, 
ie., the local lesion of the diseased part of the motor conducting path. 
Only a part of these morbid processes is accessible to electrotherapeutics,, 
such as the manifold diseases of the brain, spinal cord, and peripheral 
nerves which I have discussed in the preceding lectures (Lectures XV.- 
XX.). If these have produced the paralysis^ they must be treated in the 
manner already described. 

Another part of these causes of paralysis is inaccessible to electro- 
therapeutics and must therefore be treated by other means (internal reme- 
dies, surgical measures, baths, etc.). 

Finally, another series of cases remains in which we do not know the 
exact nature and location of the morbid process (hysteria, various forms 
of poisoning, certain paralyses after acute diseases, eta). Causal treatment 
must then be dispensed with or directed to all localities ¥diich may possi- 
bly come in question. 

& The fulfilment of the causal indication often effects our second 
object, viz. : the removal of the obstructions which prevent tiie conduction 
of stimulation through the site of the lesion. But the latter indicatioB 
is not always met in this manner, and we must then rely upon the direct 
aati-pandytio action of electrical currents. 

For this purpose their stimulating action is all important. An obatroo- 
tion to motor conduction which cannot be relieved by the stimulus of the 
will may perhaps be overcome by a more vigorous artificial stimuloa and 
thus the path also made free to voluntary excitation. If the electrical irri- 
tant is allowed to act vigorously on the proximal side of the lesion, the 
obstruction may, perhaps, be removed in this manner. In explanation of 
this phenomenon, I would refer to the well-known fact that frequent use 
of a motor conducting path diminishes the resistance of the latter (influ- 
ence of practice). In this manner we sometimes succeed in foreiBg the con- 
duction of the process of excitation by means of the electrical current ; 
when this has been achieved, the stimulus of the vrill may gradually grow 
effective and the paralysis slowly disappear. 

As a matter of course, the stimulus must be applied to the proximal 
side of the lesion (Fig. 35) ; in order to remove an obstruction (a) in the 
oonducting path of a motor nerve (n), so that the centrifugal volunlaiy 



SPECIAL ELSOTRO-THXRAPBUnOS. 



189 



prooess of stimolatioii may reach the muscle (m) undisturbed, the elie- 
trical stimulus {e) must be applied to the proximal side of the site of the 
lesion (a). Frequently, however, this cannot be done, even in periphenl 
paralysis — for example, in paralysis of the facial nerve within the Fallopian 
canal, or of the cerebral nerves at the base of the skull, or in lesions of the 
Cauda equina, etc. Our purpose could not be achieved were it not for tin 
fact that we are fortunately in the position of exerting the electrical stism- 




I 





Km. SL 

Fl«. 8B.— SohMiiatIo repwiwitiMoa of « motor pAnilyste. ii, motor oondnotlnir psth; m, noitfle: 
a, sito of lodon, obitraction to motor oondnction ; «, eleotrioal Irritant applied to oencnl side of site of 
loBon* 

Fio. M.— Sohematio reprenentatlon of a peripheral fkoial panUyids and its reflex eleotrioal itinialation 
from the trigeminofl. F//, facial nerre ; F, trinremlnna ; m, moscle ; A, akin, perlphernl distribation of 
trigemlnaii ; c, central organ (medalla oblongata) ; a, site of lesion in the facial nerve ; a, eleotrioal stim- 
oloi^ applied to the ildn. The eleotrioal ^moiant prooea mns in the direction of the arrows. 

lation in the desired locality — on ihe proximal side of the lesion — in an 
indirect, reflex manner. 

The matter is very simple when the shortest and most frequently em- 
ployed reflex arc is intact ; for example, in facial paralysis so long as the 
trigeminus is intact {vide Fig. 36). If an obstruction to conduction (a) is 
present in the facial nerve (YII) near its entrance into the Fallopian 
canal, the electrical current cannot be applied to the proximal side of the 
lesion vnth sufficient intensity. But if we irritate the integument of the 
face (/i), which is innervated by the trigeminus (V) with the electrical cur- 
rent {e) — or the trunk or individual branches of this nerve-— a centripetal 



190 



ELSOTBO-THERAPEUnCS. 



stimiilatioii is produced which is conveyed in the central organ (c) through 
the shortest reflex arc to the trunk of the facial, and now acts as a centri- 
petal stimulus upon the obstruction to conduction, in the same manner as 
if the electrical irritant had been applied centrally. 

A somewhat similar condition occurs in infantile spinal paralysis, in 
which the obstruction to conduction is situated in the reflex arc itself, but 
the sensibility of the skin remains intact ; a central irritation of the motor 

paths of conduction is also impossible in this 
instance, but the process of reflex stimulation 
may be resorted to, as will appear from the ad- 
joining figure without further explanation. 

The matter becomes more involved when 
the peripheral mixed nerves are paralyzed, and 
sensory conduction is also interrupted, as in a 
in Fig. 38. Irritation of ihe skin at h will have 
no effect upon the motor paralysis^ it will be 
lost at the point of obstruction (a), and pro- 
duce no reflex stimulation of the motor path ; 
in order to effect this, we must employ, for 
the reflex stimulus, paths which are situated 
farther forward or backward (or at the same 
level on the opposite side of the body) ; for ex- 
ample, the path h\ which is also in indirect 
reflex connection with m (indicated by the ar- 
Fio. 87.— Sohenwtio repraflentation row). According to well-known physiological 
ftuTu^^ff^^da.' 'c^'ce^^ laws, tlus rcflcx stimulation will be consider- 
SSSirS;nr'Sriu«>;5'S^ndu^^^ ably weaker than if the natural and shortest 
Sn^inTntinS; ^^Jttli^'^ reflcx path were employed. But something 
i«ion dtuatcd within the reflex arc elsc cau be effected by the electrical stimulation 

of ^ ; the obstruction to sensory conduction at a can be overcome and 
therefore made free, so that the shortest reflex path is now opened for the 
centrifugal stimulation of the path JRm, A more direct action upon the 
paralysis is thus rendered possible. This may also prove of service when, as 
so often occurs, the sensory conduction is restored earlier than the motor ; 
the sensory paths may then be employed forthwith for reflex irritation. 

The matter becomes still more complicated in central paralyses ; if the 
shortest available reflex path is situated below the site of lesion (in Fig. 
38, the reflex path h' Bm' when the lesion is located at a'), its irritation 
will have no direct influence upon the site of disease and therefore upon 
the paralysis, especially if sensory conduction is also impeded at the level 
of a'; it follows, therefore, that spinal and also cerebral paralyses, in 
which the reflexes are retained or increased, cannot be influenced (or only 
with difficulty) in this reflex manner ; this is only conceivable if, the sen- 
aory conduction being retained, the reflex irritation acts upon a' in a oen- 




SPECIAL SLEOTBO-THEKAFBUnoa 191 

trifagal direction through a cirouitous path or from more remote MDS017 
paths ; we must employ, in the main, the reflex paths which are situated 
more anterioiiy. As reflexes can also be obtained from the cerebral cor- 
tex, it thus becomes possible, in paralyses of every possible location, to 
employ the reflex stimulatioQ coming 
from tiie centres by electrical irritation ^^ 

of any part of the skin upon the paral- -^^ ^^^^ 

yzed side. This is also focilitated by 
the tact that in many of the paralyses 
in question, the sensory conduction to 
the oerebral cortex is entirely intact 
This will explain in part the BucceBsfol 
results of peripheral faradizatiou and 
galvanization in ceotral, especiaUy cere- 
bral, paralyses, and it accords very well 
with the statements of Vnlpian and 
Rumpf that the application of the bra- 
die brush to the skin of the forearm, 
in hemiplegia with anseathesia, may 
also improve the motor paralysis, 
speech, etc 

To secure theae irritating effecta, 
you may employ the various methods 
described in the general part of this 
work (page 105). In employing tlie 
galvanic current, the Ca should be ap- 
plied, at first stabile, then labile, along 
the nerves and muscles which we de- 
sire to irritate. The contractions pro- 
duced serve as a measure of the 
strength of current ; in central stimu- 
lation, when, as a matter of course, no 
contractions occur, or when the periph- 
eral part of the nerve is inexcitable, 
you should select the strength of cur- 
rent upon Correapondine healthv FlG.»-Boh«ni»tlorepmKnt»UonnftlmrB«« 

nerves. To secure more vigorous irri- ""i ■"■J "ntnii j»n\y^^ t^mi oort : bm, 
tations, make cathodal closures, and, niu»ci«; »*'A"ft"', Mnwrr pHthn uid iHn: a, 

lanon ot ■ pcrlphsnl mlMd nrrve ; a", lailan at 
U you reqmre a still stronger StimU- Ihe-nlnm molor omdncllng i«[h.; a", l«l<n •( 

ius, make repeated changes of polar- 
ity. The An may be placed at the site of the lesion, on its proximal side, 
or on some indifTerent spot. 

In using the foradic current, it is generally sufficient to apply it by 
means of moist electrodes to the nerve-trunks in question, upon the prox- 



192 ELXCTBO-THEBAPEUTI08. 

imal side of the lesion when ihe motor paths sre to be acted npcrn, upon 
the distal side when you wish to act upon the sensory paths. Or yoa may 
employ faradization of the skin, as in general faradization, or apjdy ihe 
foradio brush, either as a vigorous local application to certain onall por- 
tions of the skin (Yulpian) or as a more diffuse application with a moder- 
ately strong current (Rumpf). 

c. A further object is the remoTal of the secondary finer or groaser 
nutritive disturbances which may be present in the motor conducting 
paths and interfere with their normal function. 

We may have to deal with finer molecular disturbances, such as are 
produced in the nerves by poisons, or by prolonged inaction, perhaps also 
by the exclusion of certain central trophic influences. A single or re- 
peated moderate stimulation of the motor paths of conduction by the pro- 
cess of electrical irritation may then suffice to restore conduction. 

Next in order is the degenerative atrophy of the nerves, which arises 
from the entire exclusion of central trophic influences and is recognized 
by the De B. Although entire prevention of this degenerative atrophy 
cannot be secured, it is probable that regular fiuradic and galvanic stimu- 
lation will, at least, prevent marked atrophy of the muscles and hasten the 
restoration of the nerves and muscular fibres. The galvanic current is 
preferable ; stabile application of both poles to the diseased part of the 
nerve, then vigorous labile application, and in addition the treatment of 
the muscles which will next engage our consideration. 

d. Our final object in many cases is the restoration of the normal irri- 
tability, contractility, power, and also the normal volume of the paralyzed 
muscles. 

The surest means of improving the nutrition and contractility of &e 
muscles is the process of muscular contraction itself ; muscles which are 
often contracted become hypertrophic and stronger. 

To effect our object, viz., the relief of the atrophy and degeneration of 
the muscles, we should endeavor to increase the irritability of the contrac- 
tile substance, to produce repeated muscular contractions, to cause in- 
creased flow of blood to the muscles, and finally exert trophic influences 
upon tbem. 

As you see, these objects appear to be created for electro-therapeutics, 
especially for the galvanic current ; we may at first apply the Ca stabile, 
alternating with the An, upon the muscle itself ; then an energetic stabile 
application of both poles, either alternately or simultaneously, upon the 
motor nerve of the muscle ; finally, labile galvanization of the motor nerve 
and muscle. If more vigorous stimuli are required, cathodal closures and 
changes of polarity may be resorted to. In employing the faradic current^ 
moist electrodes are applied to the muscles and their motor nerves accord- 
ing to the rules of local faradization. 

I must also mention another method of treating muscular atrophy, viz.. 



SPECIAL BLECTBO-THBBAPSUnOS. 198 

by tbe applicatioii of feeble, oontinuous currents (1 to 4 elements). Le 
Fort and Yaltat have employed them especially in the muscular atrophy 
which is so frequent after inflammations of the joints. They appear to b# 
especially indicated in the peculiar forms of muscular atrophy without 
degenerative processes and without De B^ which may be attributed to re- 
flex influences (particularly those starting from the joints), to prolongecl 
inaction, continued use of surgical bandages, and the like ; the musolM 
present simple diminution of faradic and galvanic excitability. With 
gard to the Le Fort-Valtat method of treatment^ I refer you to my 
marks on page 120. 

A review of our previous considerations shows that we require chiefly 
the stimulating e£fects of electrical currents in the treatment of paralysig 
and atrophy, and next their catalytic eflfects (which play the chief part in 
the fulfilment of the causal indication), but that the modifying e£fecta are 
of minor importance. 

As the same method of application will suffice for all the indications 
which are to be met» the electro-therapeutics of paralysis is very much 
simplified. Apart from the methods required by the causal indication 
(treatment of the brain, sympathetic, spinal cord, or the lesions of the 
peripheral nerves) the direct antiparalytic eflfects of the current can be 
secured, as a rule, by simple faradization of the afiected nerve-trunks, or 
by the labile (most prominently), then stabile galvanization of these 
nervea In addition, it is sometimes desirable to employ peripheral cu- 
taneous irritation of such sensory nerve- trunks as have not been afEiBcted 
by the other procedures. 

These applications produce more or less rapid and complete results ; in 
especially favorable cases this may occur after one or more sittings when 
the anatomical conditions are of such a character that rapid restoration of 
conduction is possible or the way for it has been already prepared by th» 
restorative processes of nature. We may then observe the sudden return 
of movements, which were perhaps impossible for weeks and months^ as, for 
example, in paralysis of the vocal cords, hysterical paralysis, certain cerebral 
paralyses, mild rheumatic paralysis, even in paralyses which manifest the De 
B^ if the electrization is first employed at the period when regeneration has 
made a certain amount of progress. But such cases are exceptional and 
the majority of paralyses require more or less prolonged treatment. 

A few remarks will suffice with regard to the electro-diagnosis of 
paralyses, and I will merely give a short resume of the subject {vide Lec- 
tures VIL-X.). 

We very often expect that electrical examination will give us informa- 
tion with regard to the exact site of the paralysis, but our expectations are 
rarely realized. This can sometimes be done in peripheral paralyses 
when the central part of the nerve is accessible to electrical stimulation ; 

if this is inexcitable electrically, while a more peripheral portion is ex- 
13 



194 ELECTRO-THERAPBUnCS. 

citable, the lesion must be situated between the two points of irritation 
(even this is only available in cases in which complete De R is not present). 
Furthermore we may conclude from the presence of severe disturbances 
of electrical irritability (marked diminution, De B) that no true cerebral 
paralysis is present, since these changes occur alone in spinal (including 
bulbar) and peripheral paralyses. A differentiation between peripheral and 
spinal paralysis, on the other hand, is not possible from the electrical ex- 
amination alone ; bat if the paralysis is of undoubted spinal origin you 
may draw a conclusion with regard to the implication of certain parts of 
the gray anterior horns from the presence or absence of the De R 

Much more important are the data furnished us by electrical exam- 
ination with regard to the presence or absence of severe degenerative pro- 
cesses in the paralyzed nerves and muscles, and here the various forms 
and stages of the De B are of the greatest significance, because they fur- 
nish pretty accurate data concerning the histological condition of the 
nerves and muscles. For further details on the subject I refer you to the 
general part of this work. 

Finally, slighter changes (simple increase or diminution of electrical 
excitability) occur, from which certain inferences may be drawn with re- 
gard to finer molecular and nutritive disturbances which occasionally jus- 
tify important conclusions, although of slight diagnostic value. Thus, 
slight increase of excitability, which occurs in some paralyses a few days 
after their development, in others persists for a long period, leads us to 
infer the existence of slight irritative processes in some part of the motor 
tract (as in hemiplegia with contracture, in neuritic paralysis, at the onset 
of certain rheumatic paralyses, etc.). In some cases a diminution of ex- 
citability leads us to infer finer nutritive disturbances (from inaction, the 
exclusion of certain trophic influences in some spinal and cerebral affec- 
tions which do not lead to De B) ; in other cases, the atrophy of a large 
number of nerve and muscular fibres, such as is observed in bulbar par- 
alysis and progressive muscular atrophy in a part of the muscles ; or, 
finally, there are grosser changes in the muscles themselves, which cause 
atrophy or other disturbances and thus lead to a diminution of excitability 
(for example, in the muscular atrophy around diseased joints, in primary 
diseases of the muscles, such as lipomatosis, pseudo-hypertrophy and true 
hypertrophy of the muscles, etc.). From all that we know, the existence 
of the De B indicates that the paralysis or atrophy is neurotic in its origin 
(from a lesion of the peripheral or central trophic nervous apparatus) ; in 
all cases, therefore, in which marked atrophy and paralysis are found 
without De B, you may exclude their neurotic origin with some certainty, 
and regard them as due to a primary disease of the muscles ; at all events, 
serious lesions of the gray anterior columns or the peripheral tract may 
be positively excluded, although the possibility of another form of central 
disturbance of nutrition is not entirely excluded (vide pages 73, 74). 



SPECIAL ELBOTRO-THEBAPEUnOS. 195 

Before proceeding to a detailed consideration of the individual form^ 
of paralysis, I will make a few general and practical remarks 

Central application is naturally the main feature in the treatment of 
cerebral paralysis ; concerning the method I refer you to Lectures XV. 
and XVL In the peripheral treatment of the paralysis we must depart 
from the principle of applying the An to the site of lesion, on account of 
the danger of strong currents to the brain ; in such cases I usually apply 
the An to the bagk of the neck, while the arm and leg are treated peripher- 
ally. As an introduction to peripheral treatment I have sometimes allowed 
feeble, stabile currents to pass from the side of the brain lesion to the op- 
posite paralyzed brachial plexus. Caution in choosing the strength of 
current is especially necessary in cerebral paralysis, particularly when re- 
flex irritation (^trado-cutaneous brush) is employed. 

Central treatment is also most important in spinal paralysis; pe- 
ripheral treatment may sometimes be dispensed with entirely, especially 
when the nutrition of the muscles is normal In these cases we may ad- 
here to Uie rule of applying the An to the site of lesion in the peripheral 
treatment 

In peripheral paralysis chief consideration must also be paid to the site 
of lesion ; the special conditions of the case will determine the position 
and character of the applications ; the differences in effect upon the motor 
and sensory tracts, the applicability of direct or reflex stimulation must 
not be left out of account 

Very little need be added with regard to the technique of the applica- 
tions ; the strength of the current varies with the individual cases, and is 
usually chosen so that contractions will be produced ; the choice of elec- 
trodes is made according to general principles, in causal treatment as large 
as possible, in peripheral treatment the active electrode being relatively 
small. 

The duration of the sitting should not be too greats since exhaustion 
may otherwise occur. 



LECTURE XXn. 

Baetro-thei mp e ni fai of Indlyidnal Forms of PoralTsis—l. Pftralyiis of the Oonlar 
Miuoles: Pathogenetts ; Gaaes ; Methods of Treatment; Eesalto— 2. Paadjais 
of the Muscles of MssUcation— 3. Paraljsi^ of the Facial Nerre — Rheammtio 
Form; its Sitaation and Nature; Condition of Electrical Excitabilitj ; Proir~ 
nosis; Oases; Methods of Treatment ; Resolts— Other Forms of Faoxal Pazalyris 
—4. Paraljsis of the Spinal Aooessoxy Nerre— 5. Paraljsis of the Hypogloasftl 
Nerre. 

1. Pabaltbib of ths Oodlab Mubglbs. 

This occurs yery frequentlj, either as an isolated affection or as ft port 
•ymptom of serious diseases of the brain and also the spinal cord. 

The electrical treatment must depend upon the most exact diagnosis 
possible concerning the form and distribution of the paralysis, and esp^ 
dally the localization of the lesion. The recognition of the paralysis of 
indiyidual ocular muscles has reached a high grade of perfection. There 
may be isolated paralysis of single muscles or of indiyidual nenres, partial 
paralysis of the motor oculi nerve ; combined paralyses of all or of two of the 
nerves, unilateral and bilateral paralysis, and finally bilateral paralysis of 
associated muscles ; in addition, we must differentiate between complete 
paralysis and mere paresis or so-called insufficiency of the ocular muscles. 

The exact location of the lesion may be determined in many cases firom 
these relations, from the etiological factors, and from certain clinical data. 
The lesion may be situated in the orbit (affection of the three ocular 
nerves, the optic and first branch of the trigeminus) or in the middle fossa 
of the skull (affection of the three ocular nerves, and the entire trigeminus), 
or in the posterior fossa of the skull (implication of the trochlearis, abdu- 
oens, facial, acoustic nerves, etc.) ; or it may be situated in the bulbar 
nuclear region, in the medulla oblongata, pons, peduncle (nuclear paralysis 
of the ocular muscles, implication of muscles which belong together func- 
tionally, non-implication of accommodation and pupillary reflexes, implica- 
tion of other bulbar nerves, alternating paralysis, etc). Very little is 
known concerning more central lesions as causes of ocular pai*alysis ; some 
observations seem to indicate that they may be due to lesions of the cor- 
tex on the opposite side. 

It is of great importance to determine whether the paralyses should be 
regarded as prodromata or part symptoms of some other disease, especially 



SPECIAL ELBOTBO-THBRAPEUnOS. 197 

locomotor ataxia, multiple sclerosis, and the like. It is also desirable to 
obtain information with regard to the character of the lesioii} since in cer- 
tain disorders (tumor, syphilis, etc) little or nothing can be expected from 
the electrical current. 

There is no electro-diagnosis of ocular paralyses, as the muscles cannot 
be excited electrically. 

I append a few cases as illustrations of the therapeutical results : 

51. Personal observation. Eheumatic paralysis of the abducens. — ^An en- 
gineer, aged thirty-four years. Suffering for ten days from diplopia, prob- 
ably from exposure. Paralysis of the right abducens ; the eye cannot be 
moved outward beyond the median line. Qalyanic treatment : 8 elements, 
stabile transversely through the temples, galvanization of the sympathetic, 
Ga labile along the region of the external rectus (An on the left side of 
tbe neck). Immediately afterward the eye can be rotated outward some- 
what farther. After the fourth sitting, the images are closer together ; 
the eye can be moved almost to the outer angle. Cured after ten daily 
sittings. 

62. Personal observation. Paralysis of the right oculo-motor nerve. — A 
man, aged seventy years. Occasional diplopia during the past two month& 
March 20, 1867, quite sudden, complete ptosis of the right eye ; since 
then the eye is constantly closed. April 1st, complete paralysis of all the 
muscles supplied by light motor-oculi Gkdvanic treatment : 12 elements, 
Ca labile upon the eye. An behind the left ear. April 12th, distinct im- 
provement ; can raise the lid half way. Then slow return of motility in 
the remaining muscles ; not entirely cured until May 24th, after twenty- 
eight sittings. 

63. Personal observation. Paralysis of right trochlearis and insufficiency 
of right internus. — A man, aged fifty-two year& Sufiering for two weeks 
(probably in consequence of trauma) from symptoms of paresis of the 
right superior oblique with insufficiency of the right internus. October 
19th, treatment begun in ordinary manner. Immediate effect is very 
striking ; the diplopia disappeared forthwith after the sitting, but reap- 
peared on the following day. With a week's interruption, treatment was 
continued until November 15th, when patient was discharged cured. 

64. Personal observation. Bilateral paresis of the rectus extemus and 
teohAS intemus (nuclear paralysis f). — A boy, aged twelve years. Previously 
healthy ; diplopia for iM»t month, preceded by violent headache for two 
day& Examination showed vision normal, accommodation not impaired. 
Both extemi and both intemi appear very paretic. The other ocular mus- 
cles intact ; no other symptoms. Galvanic treatment : 8 elements trans- 
versely through the temples and mastoid processes ; then Ca labile upon 
the eyelids. After eleven days the muscles were improved, the double 
inu^ifes closer together. Severe epistaxis occurred, after which the diplo- 
pia disappeared subjectively, and absolute mobility of eyes to the outside 
much greater ; cured a week later. 

The methods of treatment of ocular paralyses follow very simply from 
general principles. In the majority of cases we must employ the galvanic 
current 

The application must be made first to the site of the lesion, either 



198 ELECrBCKrHEBAPEUnOS. 

through the anterior or posterior parts of the temples or the mastoid pro- 
cesses, according to the supposed location of the morbid process ; the An 
is first placed upon the paralyzed side, but in the majority of cases it is 
also advisable to apply the Ca in the same locality. A very practical 
method of application consists in placing one " medium " electrode upon 
the closed lids of the affected eye, the other upon the opposite side of the 
neck and occiput. A feeble current should be employed, with stabile sp- 
plication for one-half to one minute in each position. In addition, you 
may galvanize the cervical sympathetic in the ordinary manner. 

But the main feature in the treatment is the direct excitation of the 
paralyzed muscles by means of the Ca. The An is applied stabile to the 
back of the neck, and the Ca stroked over the closed lids, the points of 
application corresponding to the muscles to be affected ; the Ca may also 
be applied stabile for a short time. The strength of the current should be 
such that a distinct burning sensation is felt on the lids, and vigorous con> 
traction of the frontal muscles results upon stroking the temples ; the ap- 
plication to each muscle should last about half a minute. The "small" 
sponge electrode is most serviceable, but the " medium " electrode may 
also be employed. The index finger, enclosed in wet linen, may also be 
used as an electrode, the current being allowed to pass through the entire 
body in order to control its strength ; this method is more adapted to the 
faradic current 

The method of application which I have just described is emj^loyed also 
for the faradic current ; the current moderately strong, so that vigorous 
contractions occur in the orbicularis palpebrarum ; the electrode is ap- 
plied in the region of the muscle which we desire to irritate. We may 
come in closer contact with the muscles by employing a wet brush as an 
electrode, or a fine olive-tipped electrode, introducing it into the conjunc- 
tival sac and bringing it as close as possible to the muscular insertions. 
But this is very annoying to the patient and is insufficient to produce con- 
traction of the ocular muscles. Mydriasis, etc., may also be treated in 
this manner with two fine brush electrodes, applied opposite one another 
upon the border of the cornea ; this is best done during narcosi& 

In this manner we seek to effect a direct excitation of the paralyzed 
muscles and motor conducting paths ; this purpose, however, can only be 
effected in a feeble and impeHfect manner, as is evident from the impossi- 
bility of thus producing contraction of the muscles. 

The results of electrical treatment are very favorable in many cases ; 
the temporary improvement immediately after treatment is especially evi- 
dent in many instances, the movements of the eyes becoming more free 
and the double images approximating more closely. If this persists, re- 
covery ensues rapidly ; but more frequently the improvement disappears 
and a very long time may elapse before recovery occurs. Finally, there 
are cases in which galvanic treatment^ like every other, proves useless. 



SPECIAL BLECrrBO-TUBRAPBUnO& 199 



2. Pabaltbis or thb Musglbb or MAflnoATioN 

(the motor root of the trigeminus) is extremely rare. It is prodnoed most 
freqnentlj by intracranial, especially basilar, affections, but may also oc- 
cur in certain bulbar diseases (Erb) ; it is very rarely due to diseases of 
more central portions of the brain (pons, central ganglia, cortex, etc). 
Atrophy, loss of faradic excitability, De it are occasionally associated with 
the paralysis. 

Electrical treatment is applied in the same manner as in paralysis of 
the ocular muscles : firsts causal treatment (galvanic current transversely 
through the anterior or posterior auricular region, or obliquely from the 
anterior auricular region to the opposite side of the neck, etc.) and then 
direct excitation of the muscles of mastication with the faradic current, 
with the Ca labile or Ca closures, eta, at the motor points (Fig. 29, page 
122) ; the external muscles of mastication (masseter, temporal) are aJone 
aooeesible. The results depend naturally upon the cause of the disease. 



8. Pabaltsis or the Facial Nebvx. 

This forms one of the most frequent and feyprable objects of electro- 
therapeutics, and there is scarcely anoUier 4orm of pandysis concerning 
which we are so well informed. 

This is especially true of rheumatic facial paralysis, the most frequent 
and practically important variety ; its symptomatology, electrical relations, 
and treatment are typical of all other forms of facial paralysia 

Nothing is more readily recognized than a rheumatic facial paralysis, 
but it is more difficult to determine the site and character of the lesion. 
The symptomatology renders it positive that the nerve-trunk itself is af- 
fected, and probably with greatest frequency in that portion which is sit- 
uated between the stylomastoid foramen and the division of the nerve 
into the pes anserinus ; the process may also extend farther into the Fal- 
lopian canal, rarely to the geniculate ganglion, and scarcely ever to the 
base of the skulL 

The true character of the affection is stiU quite obscure, though there 
is very little doubt that we have to deal with a slight rheumatic neuritis. 
The exposed situation of the nerve in the position mentioned, the delicacy 
of the integument at this spot with the absence of protection from a 
growth of hair, and the tendency to sweating in this region render it explic- 
able that rheumatic influences, affecting one side of the face, should lead 
so readily to an inflammation of the nerve. On the other hand the nar- 
row calibre of the Fallopian canal causes marked compression of the nerve, 
when it has undergone slight inflammatory swelling within the canaL 



300 ILEOTRO-THEBAPEUTICS. 

while if the process is confined to the short stretch outside of the Fallo- 
pian canal, it will jntxluce sUghter injury to the nerve. 

Thus, some cases may recover in two to three weeks, in others the 
paralysis lasts many months, even a year or more, although the symptcnns 
were identical at the outset 

Electrical examination enables us to make a veiy early and aocorate 
prognosis in individual cases of rheumatic facial paralysis. 

In the first group of cases there is no change of electrical excitabilitj, 
at most a very slight increase for one or two days at the beginning of the 
paralysis. The faradic and galvanic excitability of the nerves and muscles 
also remains normal, both quantitatively and qualitatively, during the far- 
ther course of the disease. These cases recover in two or three weeks 
(mild form of rheumatic facial paralysis). 

In a second group there is no change in the beginning, vnth the exoep- 
tion perhaps of a slight increase of irritability, but toward the end of the 
first week a slight diminution of the faradic excitability of the nerve and 
muscles may be recognized, more distinct in the diminution of the maxi- 
mum contraction than in the later occurrence of the minimum contraction ; 
this does not increase to any notable extent^ but during the course of the 
second or perhaps the third week, the muscles present the characteristic 
changes of the De B and these are often very pronounced. This consti- 
tutes the partial De R. The muscles may often be made to contract norm- 
ally (short contraction, predominance of Ca CI 0) when the nerve is 
stimulated, but react abnormally upon direct excitation (slow contraction, 
predominance of An CI C). This form also presents a relatively favorable 
prognosis. The disease recovers in four to six weeks, and rarely continues 
eight to ten weeks ; the mobility is often restored almost completely be^ 
fore the changes in the galvanic irritability of the muscles have dis- 
appeared. Eecovery is complete without the development of subse- 
quent contracture and spontaneous spasmodic twitchings in the muscles 
(medium form of rheumatic facial paralysis). 

Finally, a large number of cases belong to the third group, which at 
once presents all the symptoms of complete De R. The prognosis is then 
decidedly unfavorable, as these cases always require a very long period 
for recovery. The first traces of returning mobility do not begin until 
the lapse of two or three months, and several months may further elapse 
before recovery is nearly complete; this does not occur usuaQy until 
after a certain s(iffiiess of the paralyzed side of the face, contractures, 
muscular twitchings, etc., have persisted for some time. This may occupy 
from six to fifteen months and traces of the former paralysis may often 
remain visible forever to the experienced eye (severe form of rheumatic 
fiocial paralysis). 

We are therefore able, at the end of the first week, to give an almost 
Absolutely certain prognosis with regard to the duration of the diseaseu 



SPECIAL £. EOTRO-TUBBAPEUTICS. 201 

If there is no diminution in the irritability of the nerre at the end of the 
first week, the disease will last two to three weeks, and four to eight weeks 
if the irritabOily is slightly diminished; finally, if there is marked di- 
minution of excitability at this time, it will last at least four to twelve 
months. 

There is no doubt that the variable course of this affection depends 
upon the varying severity of the lesion, and that the latter depends in 
great part upon the location of the morbid process. If the latter occurs 
outside the Fallopian canal, serious compression of the nerve is net possi- 
ble, the lesion remains slight and rapidly disappears ; it it extends into 
the oanal, the interference with conduction becomes complete, not only 
the motor but also the trophic conduction is entirely prevented and the 
various grades of De R make their appearance. 

The following cases will serve as illustrations of this frequent affection : 

56. Personal observation. Rheumatic facial paralysia (mild form), — ^A 
woman, aged twenty-four years. For six days has had rheumatic paralysis 
of the right facial nerve. Uvula and velum palati straight, no disturbance 
of taste or hearing. Electrical iiTitability of the nerve and muscles en- 
iirdy normal Gbdvanic treatment : first traces of returning mobiUty on 
the tenth day ; complete recovery on the eighteenth day. 

56. Personal observation, Hheumatic facial paralysis (mild form J, — A. 
porter, aged forty-one years. Acquired right facial paralysis a week ago 
from exposure ; complete paralysis of all facial branches, reflexes abol- 
ished, no disturbance of tcuste, velum palati unaffected. Faradic and gal- 
vanic excitabihty entirely normal G^vanio treatment. Ck)n8iderable 
improvement on eleventh day ; recovery almost complete on seventeenth 
day ; discharged cured on twenty-third day (after five sittings). 

57. Personal observation, Bheumatic facial paralysis (moderate form). — 
A forester, aged forty-one years. Suffering from left facial paralysis, the 
result of exposure. Status on the eighteenth day : complete left facial 
panJysis. Uvula and velum palati normal, no disturbance of taste. Par- 
tial De R (slight diminution of irritability of the nerve to both currents, 
characteristic increase and qualitative change of muscular excitability, viz., 
An CIC >Ca d C, increased mechanical irritability). Galvanic treatment 
employed and patient discharged cured on the sixty-fifth day. 

58. Personcd observation. Rheumatic facial paralysis (moderate form), — 
A student, aged twenty-one years. Has had left rheumatic facial paralysis 
for four days ; all the ftunal branches paralyzed, uvula and velum palati 
normal ; hearing normal, disturbance of taste on left anterior half of 
tongue. Electrical excitability still normal On the seventh day dis- 
tinct diminution of f iradic excitability of nerve-trunk, no trace of De R. 
On the thirteenth day faradic excitability still more diminished, espe- 
cially in the mental branches ; distinct degeneration reaction in the muscles 
of the chin ; traces of returning mobility in the frontal muscle. At the 
end of two and a half months mobility in distribution of frontal branch 
entirely restored, very deficient in muscles upon upper jaw and chin. 
Taste restored. Partial De R especially distinct in the muscles named 
Qalvanic treatment again resumed (after intermission of two months) and 
rsoovery occurred in four weeks. 



202 ELECTB0-THEEAPEUTIC8. 

59. Personal obeervalion. BheumaHc facial paralysis (severe farmy —- 
A woman, aged sixty-two years. Seen on second day, after sudden oc> 
currence of right rheumatic facial paralysis. Ck>mplete paralysis of all facial 
branches ; uvula and velum normal Complete De B developed in a tj^- 
cal manner. Ghdvanic treatment (Ca labile along the ner\'e and musses. 
An behind the ear) begun at once. On the sixty-sixth day, first trace of 
mobility in frontal muscle. On the one hundred and forty-fifth day, im- 
provement is quite advanced, but slight contracture of the muscles has de-> 
veloped, especially around the angle of the mouth. Very slow progress of 
recovery. At the end of thirteen months disease is stHl recognizable by 
the impaired mobility of the muscles, contracture and spasmodic twiich- 
ings. 

60. Personal observation. Bheumatic facial paralysis (severe form). — 
A man, aged thirty-six years. Came under observation five days after the 
sudden development of right facial paralysi& Complete paralysis of the 
facial branches, implication of the auricular, disturbance of taste, slight 
hyperacusis, velum palati normal Complete De B developed in next two 
weeks. Oalvanic treatment (twice a week). First traces of mobility in 
frontal muscles two months later; recovery almost' complete after the 
lapse of three additional months ; slight contracture persisted. 

The first feature of the electrical treatment of rheumatic facial paraly- 
sis is the direct treatment of the lesion itself ; this is best done by means 
of transverse conduction of the galvanic current through the auriculo- 
mastoid fosssB or the petrous portion of the temporal bones, in order to 
relieve the neuritis ; then stabile application of the An (especially in re- 
cent cases), followed by longer or shorter application of the Ca ; the sitting 
should last one or two minutes with a current of 6 to 10 element& 

The removal of the obstruction to conduction in the nerve is not so 
simple, because the current cannot be applied with certainiy to the proxi- 
mal side of the site of lesion. But, fortunately, we have at our disposal 
an extremely effective reflex arc, which facilitates greatiy the production 
of stimulation on the proximal side of the lesion. The trigeminus is en- 
tirely intact, and between it and the facial nerve is a direct reflex connec- 
tion, which is kept in constant use by innumerable physiological processes. 
Every vigorous stimulation of the facial branches of the trigeminus must 
therefore give rise to an active centrifugal excitation in the trunk of the 
facial nerve. For this reason, peripheral faradization and galvanization of 
the face may be of decided benefit. 

This method will also fulfil the final indication, viz. : the removi^ of 
the finer and grosser nutritive disturbances in the paralyzed nerve& This 
is useful in the mild and moderate forms, but it can by no means prevent 
the progress of degenerative atrophy in severe cases ; however, it may has- 
ten the restoration of the muscles in such cases, and should, therefore, not 
be omitted. 

This peripheral treatment — with the galvanic current — consists in the 
application of the '* medium " An behind the ear of the paralyzed side, and 



SPECIAL ELBOTBO-THEBAPBUTIOa 20S 

the "small" Ca labile along the muscles and nerve with soffioient vigor. 
First stroke the plexus anserinus and its chief branches, then the individ- 
ual muscles ; it is advisable to treat the orbicularis palpebrarum directly, 
in order to increase its tonus, by stroking the lids and closing them by 
gentle pressure with the electrode. The strength of the current should 
be such that vigorous contractions occur together with a distinct burning 
sensation above the eyelids (6 to 10 elements are usually sufficient) ; dura- 
tion, one to three minutes. 

The peripheral faradic treatment is similar in character ; in the mild 
and moderate forms the individual nerve branches and muscles should be 
direcUy stimulated; in the severe form no muscular contractions will 
ensue, and the strength of the current then depends upon the sensations 
of the patient, which should be quite vivid. . 

The results of treatment vary greatljr according to the severity of the 
case ; you should never expect to be able to convert a severe case into a 
moderate or mild one. 

The severity and average duration of the affection are fixed and cannot 
be much affected by treatment However, I believe that in the mild and 
moderate forms electrical treatment will hasten recovery, and, in severe 
forms, prevent the incurability of the affection, further complete restora- 
tion, and antagonize the development of secondary contractures and spas- 
modic conditions. 

Electro-therapeutics is usually quite powerless against secondary con- 
tractures in the face, especially those of long-standing ; I have employed, 
without effect, stabile and labile galvanization, faradization of the antago- 
nists, etc You will be compelled generally to resort to other procedures 
(mechanical extension, massage, etc.). 

The electrical treatment of the other forms of facial paralysis does not 
require a long explanation. These forms may be produced in various 
ways, which must give rise to certain modifications of treatment The 
causes include inflammations of the parotid gland or erysipelas, traumatism 
(incised wounds, operations, pressure of the forceps during delivery), le- 
sions of the petrous portion of the temporal bone and the base of the skull 
(otitis media, caries, fractures of the temporal bone, hemorrhages, tu- 
mors, aneurisms at the base of the skull), or an affection of the facial nu- 
cleus in the medulla oblongata (in bulbar paralysis, etc.), of the tract of 
the facial nerve in the brain (in apoplexy, cerebral hemiplegia), and, 
finaUy, of the motor centres of the facial ip the cerebral cortex (in ab- 
scesses, tumors, etc.). The symptomatology of the paralysis, its combi- 
nation vnth various other disorders, and the condition of electrical excitability 
are dependent upon the localization. In pure cerebral paralysis, the elec- 
trical excitability is entirely intact ; in bulbar paralysis, simple diminution 
of excitability may be present in the affected facial branches and some- 
times partial De B can be demonstrated ; in basilar and other forms of 



304 ELECTR0-THBRAPBDTI08. 

peripheral paraljsiB the electrical excitability may vary : De B (paxidal or 
oomplete) is usually present, sometimes simple diminution, Tery rarelj 
increase of excitability, and still more rarely the latter remains intact. 

There are certain modifications in the electrical treatment of these 
forms of paralysis, occasioned by the situation of the lesion. The latter 
must be Uie chief object of electrical application ; this is effected in pe- 
ripheral traumatic lesions at the spot in question, and in affections of the 
petrous portion of the temporal bone, the ear, and the base of the skull, 
in the same manner as in the rheumatic form ; in bulbar paralysis, trans- 
versely through the mastoid processes, or obliquely from the anterior au- 
ricular region to the opposite side of the back of the neck ; in true cerebral 
disease, employ the appropriate methods of application, such as haye been 
described before, together with galvanization of the sympathetic The 
peripheral treatment, whether favadic or galvanic, may be the same in all 
these ca8e& 

4. Pabaltsis of thb Sfwal Acgbssobt Nxbvx. 

This affection is rare, especially the implication of the external brandi 
of the nerve, which is distributed to the stemo-deido-mastoid and tra- 
pezius musdes. The paralyses of the inner branch, which supplies the 
larynx, pharyngeal muscles, and a portion of the velum palati will be dia- 
<m8sed at a later period. 

Paralysis of the stemo-deido-mastoid and trapezius is readily recog- 
nized, but its cause and the exact site of the lesion cannot be determined 
always with certainty. It may occur with or without atrophy of the mus- 
des, with or without De R You will have to deal most frequently with a 
peripheral lesion of the nerve, either within or without the spinal canal, 
next in frequency with a bulbar lesion ; not infrequentiy it is a part- 
syniptom of progressive muscular atrophy, especially of the "juvenile" 
form, which has been previously referred to. 

The electrical treatment is carried out according to the prindples laid 
down with regard to facial paralysis, modified merely by the situation of 
the lesion and the affected muscles ; causal treatment, therefore, through 
the mastoid processes, or galvanization of the cervical portion of the spine, 
etc., then direct peripheral treatment in the well-known positions. 



5. Pabaltsis of ths Hypoglossal Kebvs. 

This occurs not infrequently, but is usually a part-symptom of central 
affections, as in progressive bulbar paralysis, and very commonly in ordi- 
nary cerebral hemiplegia, more rarely in cortical lesiona The diagnosis 
ci tiie site of the lesion can be readily made, in most cases, from the gen- 



SFJ£OIAL IfiLECTKO-TlLBBAPSUnOS. 205 

eral syn)ptomaix>log7. Peripheral paralysis of fhe hypoglossal nerve may 
also occur (from mjuries, operations, pressure of tumors, cicatrices, etc.), 
but has no great practical significance. 

In purely cerebral paralysis of the hypoglossus, atrophy of the tongue 
does not ensue, nor is there any change of electrical excitability. But as 
soon as the nuclei of origin in the medulla oblongata are affected, or the 
peripheral tract of the hypoglossus involved, atrophy of the tongue is 
never absent, and diminution of the electrical excitability of the organ and 
even I>e B may be observed. Brenner noticed the latter in a case of divi* 
sion and in another of compression of the nerve. I have observed partial 
De R in progressive bulbar paralysis. 

The treatment is applied according to general principles : direct^ ac- 
cording to the location of the cerebral lesion; when situated in the me- 
dulla oblongata, either transversely through the mastoid processes, or the 
Ca is applied to the motor point of the hypoglossus (vide Fig. 29, page 
122) and pressed deeply below the angle of the lower jaw, the An being 
applied high up in the neck. 

In the peripheral treatment by means of the galvanic current the An 
is also applied to the neck, the Oa in the position just mentioned, either 
labile or with repeated cathodal closures ; or the Oa is applied directly to 
the tongue, either protruded or lying on the floor of the mouth. It is 
then advisable to employ an interrupting electrode which is insulated as 
&r as the sponge. In the external application, movements of deglutition 
are also produced, and these prove beneficial to some of the muscles of the 
tongue. The same electrode may also be used for the faradio current^ 
with which you may either stimulate the trunk of the nerve in the positioiii 
referred to, or cause contractions in the tongue directly. The current 
should always be sufficiently strong to produce distinct contractions. 



LECTURE XYTTT. 

Baofero-therapeutioB of IndiTidaal Fonni of ParalysiB (Oontinned) — 6. FttalTieB of 
the Neck and Tronk : PathogeneBis ; Gaaee ; Methods of Treatment — 7. Pazaljeee 
of the Upper Limbs : Pathogenesis ; Symptomatology ; Eleotio-diagnosis ; Caaes ; 
Methods of Treatment ; Besnlts — 8. Paralyses of the Lower Limbs : Patbogenaais 
and LndiTidoal Varieties ; Eleotro-diagnosis ; Cases ; Methods of Txeatmeat ; Ba> 
iolte. 

6. Pabaltses of the Neck and Tbumk. 

Umdsb this heading I include the isolated or combined paralyses of aU 
muscles of the trunk, of the thoracic, back, and abdominal muscles, espe- 
ciallj the larger and smaller muscles moving the scapula^ the extensors oi 
the neck and back, and finally the most important muscle of inspiration, 
viz., the diaphragm. 

' These are not, on the whole, very frequent forms of paralysis ; some of 
them may be entirely isolated, and due to traumatic or inflammatoiy 
lesions of the nerves, to compression from diseases of the vetebrse, etc 
Usually, however, we have to deal with more complicated cases, ynih com- 
bined paralyses of various muscles and groups of musdes, as symptoms of 
central, especially of spinal diseasea These muscles are paralyzed and 
atrophied with relative frequency in progressive muscular atrophy, espe- 
cially in the juvenile form, in which the most remarkable combinations of 
iktrophy occur in these parts ; in the typical form, on the other hand, they 
generally do not occur until the later stages, and the paralysis of the dia- 
phragm is then not infrequently of fatal significance ; paralysis of the mus- 
•des of the back is also not infrequent in so-called pseudo-hypertrophy of 
the muscles. 

Some of these paralyses are of considerable importance vnth regard to 
the patient's ability to work (as paralysis of the serratus, the dorsal exten* 
sors, the diaphragm), while others produce insignificant disturbances and 
deformities, which are quite thoroughly compdhsated by the vicarious 
function of intact muscles. It will be impossible to enter upon a more 
detailed symptomatology in this place. 

Nor can much be said with regard to the electrical relations of these 
paralyses ; with few exceptions (serratus, rhomboids, levator anguli scax>- 
ulffi, diaphragm) a direct examination of the muscles is alone possible, 
Although there are some motor points which may be employed. Occasion^ 



SPECIAL ELECTRO-THEKAPEUnCS, 207 

ttify a simple diminution of electrical excitability occurs, in other cases 
marked degeneration reaction, and at times no change can be found. 
This depends, as a matter of course, upon the location of the cause of par- 
ftljsis and requires no further explanation. 

61. ObsenxUion by 0. Berger. Paralysis of the right aerralus magnua, qfier 
typhoid/ever. — A soldier, aged twenty-six years. Taken sick with typhoid 
fever ; toward the end of the fourth week sudden violent pains developed 
in the region of the shoulder, and radiated into the arm and along the 
axillary space ; at the same time a sort of " paralysis " developed in the 
right arm, which could no longer be raised to the vertical position. The 
pains gradually subsided. Sixth months later, an isolated complete par- 
alysis was found in the right serratus magnus muscle. All the other 
muscles appeared unaffected ; no ansesthesia, pressure on brachial plexus 
not painfuL The serratus appears very shghtly atrophied ; the mradic 
and galvanic excitability of the muscle and its nerve is moderately dimin- 
ished. Electrical treatment ; galvanic current through the long thoracic 
nerve to the muscle ; local faradization of the muscle ; marked improve- 
ment developed after a short period of treatment. At the end of two and 
a half months the arm can be raised readily to an angle of 120'' ; the elec- 
trical excitability has improved. Complete recovery was not effected, 
however, by continuance of treatment. 

62. Observation by Duchenne. Paralysis and atrophy of the diaphragm 
cured by faradization, — A mechanic, aged twenty-five years. Suffering 
from progressive muscular atrophy ; marked difficulty of respiration, es- 
pecially in walking and on the ^ghtest exertion. Beversal of the respir- 
atory type occurs upon forced breathing ; at each inspiration, the epigas- 
trium and hypochondriac regions are retracted, and protruded during 
expiration. This symptom, which had lasted two weeks, was attributed 
to paresis of the diaphragm. Regular faradization of the phrenic nerves 
reUeved the symptoms in a few weeks ; respiration became normal, and 
the patient could return to work. 

63. Personal observation. Progressive muscular atrophy ^juvenile form). 
— A man, aged forty-four years. Noticed, in his fifteenth year, that the 
right arm became weak and emaciated, but he was always able to work. 
For a year past, increasing feebleness of various movements of the upper 
limbs, and also a diminution in the power of the lower limbs ; no pains or 
parcesthesia. November, 1880, examination showed weakness and atrophy 
of the muscles of the neck, and trapezii and latissimi dorsi ; paralysis 
and atrophy of both serrati ; the lower portions of both pectonds have 
entirely diuippeared. The deltoids are very well developed, the left being 
decidedly hypertrophic, as are also the supraspinati and infraspinatL 
Flexors and extensors of arms, especially the right, atrophic and paretic. 
The muscles of the forearms (with the exception of the supinator longus) 
and hands entirely normal The extensors of the back, on both sides of 
the spine, very airophic and paretic ; corresponding lordosis of the lum- 
bar spine ; waddling gait ; weakness and wasting of the right gluteal 
muscles ; weakness of both ileo-psoas muscles, especially the right ; par- 
alysis and atrophy of right tensor vaginse femoris ; paresis in entire dis- 
tribution of both peroneal nerves, complete paralysis of tibiahs anticus. 
Electrical excitability of the atrophic muscles markedly diminished ; no 
trace of De R Ghdvanic current applied to the back, along the entire 



308 BLEOTBCHrHBBAPEUnCS. 

n)in6 ; in addition, Tigoroos peripheral galvanization of the diseased rnnfr 
des and their nerres. Unexpected improyement occurred ; after Beveral 
months' treatment all moyements could be performed ^ith more vigor, and 
the patient is very well satisfied with the result, as he was again able to 
work steadily. As a matter of eoume, the old dmmio disorders wen not 
relieved. 

With regard to the methods of electrical treatment, I may refer yon to 
general principlea Under certain circumstances, however, it may beoome 
difficult to treat the lesion itself; occasionally an application may be made 
to a neuritic or traumatic lesion of the brachial plexus, or to the ^inal 
oord from the cervical to the lumbar enlargement. But the direct treat- 
ment must generally be restricted to the paralyzed and atrophic musdee, 
and this may be done with the faradic or galvanic current, according to 
the principles of local faradization. Vigorous currents, large electrodes 
and great perseverance are requisite in the treatment 

In paralysis of the serratus magnus, it is best to vpplj the An to the 
cervical vertebne, and the Ca to the long thoracic nerve in the snpni- 
davicular fossa {vide Fig. 29), in the axilla and along its course across the 
ribs ; the muscle itself is accessible with difficulty to direct stimulation, 
most readily when the arm is raised and supported. 

In paralysis of the sacrolumbales large electrodes and vexy stiaxig 
currents (closure, change of polarity) must be employed, the patient bend- 
ing backward somewhat in order to render possible a full contraction of 
the muscle. 

In paralysis of the diaphragm, direct stimulation of the muscle will be 
useless, as the amount of current which can reach it will be scoreelj 
ever sufficient ; it may be attempted by passing the current transv^se- 
ly through the costal region, or from the back to the epigastriiun and 
the other points of origin of the diaphragm. But it virill generally be 
better to apply one pole in the epigastrium or along the insertion of the 
diaphragm into the ribs and the other pole (Ca) to the phrenic nerve in 
the neck {vide Fig. 29). 

Paralysis of the abdominal muscles always requires local stimulation of 
the muscles at all their motor points ; the An being placed upon the back, 
the Ca is successively moved over these various pointa 



7. Paealybis of the Ufpeb LmBa 

Scarcely any part of the body is so often the object of electrical treat- 
ment as the upper extremity, and this especially on account of the great 
frequency and variety of paralyses in this part All possible varieties may 
occur — isolated paralysis of single muscles or of certain groups of mu8cle% 
paralysis of one or another nerve or combined paralysis of several of tbem 



SPECIAL ELECTRO-THERAPEUTICS. 209 

op to complete inaotiviiy of the entire limb, with or without atrophy, sen- 
sory, vasomotor, or trophic disturbances. 

These forms of paralysis are very important because they give rise to 
important disturbances of function and seriously interfere with the useful- 
ness of the patient, They are also very interesting on account of their 
manifold etiological relations and their significance as symptoms of an 
entire series of important central diseases, not less on accoimt of the ad- 
Tanced development of their symptomatology and diagnosis, and the man* 
if old character and results of electro-therapeutic measures. 

I will confine myself however, to a short sketch of these features, since 
the previous general remarks render detailed consideration unnecessary. 

The etiological factors of these paralyses, which are of prime import* 
ance with regard to the choice of the method of appUcation, are very mani- 
fold. I will premise that paralysis of the upper Hmb is a very common 
feature in the symptomatology of central diseases; it plays a part in 
every cerebral hemiplegia, and may occur in all possible diseases of the 
spinal cord, such as acute and chronic anterior poliomyeUtis, amyotrophic 
lateral sclerosis, multiple sclerosis, cervical myelitis and meningitis, etc. 
Much more frequent and varied are the peripheral paralyses of the upper 
limba They are produced most frequently by traumatic influences, such 
as simple pressure and external compression, which very often cause par- 
alysis of individual nerves ('' sleep " paralysis, " crutch " paralysis), incised 
wounds, blows, gunshot wounds, fractures and dislocations, surgical ap- 
pliances and operations. A series of paralyses of the upper limb ate due 
to exposure, others to neuritis of certain nerve-branches or of the brachial 
plexus ; a not infrequent cause is inflammation of the joints, especially of 
the shoulder and elbow, which leads in part to neuritic paralysis, in part 
to muscular atrophy with corresponding paralysis (especially in the del- 
toid). Finally toxic paralyses (particularly lead palsy) are apt to be local- 
ized in certain neuro-muscular tracts of the upper limbs. 

The symptomatology depends upon the situation, localization and 
extent of the cause of paralysis ; if the circumflex is alone affected, 
paralysis of the deltoid occurs with its well known effects upon the 
ability to raise the arm ; paralysis of the musculo-cutaneous interferes 
vdth flexion of the forearm (from paralysis of the biceps and brachialis in- 
temus) though not completely, because the supinator longus, which 
is a flexor of the forearm, often acts vicariously to an astonishing ex- 
tent ; paralysis of the radial (most frequently the so-called ** sleep " 
paralysis) annihilates the function of all the muscles on the extensor 
aspect of the forearm (extensors and supinators) in a characteristic and 
typical manner, and also the function of the triceps when the lesion is 
situated higher (" crutch " paralysis, dislocation of the shoulder) ; paralysis 
of the median interferes with flexion of the wrist and fingers, pronation 

and the action of the thenar muscles, while paralysis of the ulnar renders 
U 



410 BLBOTRO-TnERAPEUTIOa 

dflBcult the ulnar flexion of the hand and flexion of the last three flnger% 
and paralyzes the muscles of the hypothenar eminence, the interoseei and 
the adductor poUids (impossibility of extending the last two phalanges^ 
main en griffe). In all these paralyses senscny disturbances of the nerve 
and its sensory distribution may be present and contribute considerably 
to a more accurate diagnosis. 

The electrical examination of paralyses of the upper limb aflbrds yery 
valuable data in several respects. In the first place the exact site of the 
lesion may be frequently recognized by the fact that the peripheral por- 
tion of the nerve is still excitable while the central part is inexcitable on 
account of the obstruction to conduction, as for example in compression 
pandysis of the radial nerve ; indeed, the peripheral character of almost 
all peripheral paralyses of the arm may be demonstrated in this manner 
by the ineffectual iiTitation of the brachial plexus in the supraclavicular 
fossa, provided that complete De R has not entirely destroyed the irrita- 
bility of the nerves. 

Electrical examination also furnishes you with the usual information 
eonceming the presence or absence of gross nutritive disturbances in the 
paralyzed nerves and muscles, from the presence or absence of the De R 
This informs us concerning the severity of the lesion and not infrequently 
concerning its cause (for example, in radial paralysis, in which the ordi- 
nary compression paralyses usually present normal excitability, while 
complete De R generally occurs in lead palsy). All possible grades of 
De R may be observed, the complete form in severe traumatic or neuritic 
paralysis, lead palsy, infantile spinal paralysis, the partial form in more 
mild compression-paralyses, progressive muscular atrophy and amyotrophic 
lateral sclerosis, while in very slight compression-paralyses (for example, 
in '* sleep " paralyses) and in those whose origin is located in the upper 
cervical cord or brain the electrical excitability is entirely intact, or, at the 
most, presents slight diminution, in very rare cases a slight exaggeration. 

In addition to those mentioned above, there are a number of forms of 
combined paralyses, in which several nerve tracts are affected at the same 
time or in which the more or less numerous paralyzed muscles belong to 
various peripherial nerve branches (probably to a certain tract in the 
roots of the brachial plexus or to a definite spot in the spinal cord). The 
former includes the paralyses (often very extensive) following luxations of 
the shoulder and elbow joints and fractures of the humerus, and the 
majority of central paralyses of the arm ; the latter embraces many cases 
of progressive muscular atrophy (especially the juvenile form), advanced 
eases of lead palsy, certain forms of paralysis after delivery, and the com- 
bined ''shoulder-arm" paralysis (deltoid, biceps, brachialis internes, 
supinator longus and infraspinatus) first described by me, and which is 
usually situated in the roots of the brachial plexus starting from the fifth 
and s^h cervical nerves (in the region of or above the so-called supra* 



SPECIAL ELECTB0-THEBAPEUTIC8. 311 



• 



cbiTictdar point, vide Fig. 29), perhaps also in the corresponding parts of 
the anterior gray columns of the spinal cord. The remarks previously 
made concerning symptomatology and electro-diagnosis also apply to 
these combined paralyses. 

I refi^ you to the histories of cases mentioned in previous lectures 
(Obser^nitions 6, 6, 8-12, 15, cases of paralysis of the upper limb from cere- 
bral diseadbs ; Observation 34, chronic anterior poliomyelitis ; Observation 
35, progressive muscular atrophy ; Observation 37, iilnar paralysis ; Ob- 
servation 38, combined ** shoulder arm " paralysis ; Observation 39, deltoid 
paralysis ; Observation 40, paralysis following dislocation of the humerus ; 
Observation 41, radial paralysis), and may confine myself, therefore, to 
the recital of a few instructive cases. 

64 Personal observation. Paralysis of tJie left musculo-cutaneous nerve. — 
A man, aged thirty-seven years. May 29, 1879, upon getting up he noticed 
numbness on flexor side of left forearm and weakness of the left arm ; 
cause unknown. 

June 3d. — The sole disturbance is venr marked interference with 
flexion of left forearm, which is only effected by vigorous contraction of 
the supinator longus ; the biceps and brachialis intemus are completely 
paralyzed ; coraco-brachiahs normal. Distinct dulness of all varieties 
of sensation in the forearm in the distribution of the external cutaneous 
nerve. Electrical examination : Normal contraction of the muscles on 
the right side may be obtained by irritating the supraclavicular point ; 
on the left side, the deltoid and supinator longus alone contract, the 
biceps and brachiahs intemus remaining flaccid. At a later period partial 
De K occurred in the flexors of the forearm. Gkdvanio treatment at 
the supposed site of lesion, then irritation of the supraclavicular point 
and peripheral galvanization of the muscles. Improvement soon oc- 
curred and the patient was discharged cured after eight to ten weeks. 

65. Personal observation. Traumatic paralysis of the left median and 
muscxUo-cutaneous nerves, — A soldier, aged twenty rour years. Wounded 
August 4 1870 ; tract of wound from anterior half of left deltoid to im- 
mediately underneath the angle of the left scapula. AuGesthesia and 
paralysis (with severe pains) in entire distribution of left median nerve ; 
also paralysis of biceps and brachialis internus (inner half). 

October 8, 1870. — Very marked paresis of all these muscles, diminished 
sensibility in median distribution to the hand ; moderate atrophy of the 
muscles and great tenderness on pressure. Complete De K in median 
distribution, partial De B in biceps. Galvanic treatment in supracla- 
vicular region, then Ca labile along the nerves and muscles ; immediate 
improvement of mobility. Fourteenth sitting, sensibility of fingers re- 
stored ; flexors of forearm act normally ; no very great improvement in 
the median distribution. Patient left after twenty-one sittings. 

66. Personal observation. Paresis of the right ulnar nerve, — A man, aged 
thirty-four years. A year ago suffered from similar affection which was 
relieved by the galvanic current after a few sittings. For three days has 
had feeling of numbness, anaesthesia and weakness, in right hand. Sensa- 
tion markedly diminished in distribution of middle cutaneous nerve to 
forearm and ulnar nerve to hand ; mobility impaired in ulnar distribution. 
Galvanic treatment : An to the ulnar nerve above the elbow, Ca stabile 
and labile to the skin and musdes. After a short application, sensibility 



\ 



212 BLEOTBO-THSB APEUnOS. 

• 

returns under the An, and on passing it down the forearm sensation 
gradually returns to all parts which have been touched by it ; mobility 
also appears improved after the sitting. Complete recovery in four days. 

67. Personal obseroalion. Crutch paralysis of the right radial nerve 
{traumatic paralysis of the sciatic), — A soldier, aged twentj-five yeara 
Wounded August 4, 1870 ; gunshot wound of the Imee, entered anteriorly 
next to the patella, emerged in the middle of the thigh posteriorly near 
the sciatic nerve ; complete paralysis of the sciatic with De R 

September 24th. — Patient began to walk a little with crutches, but soon 
noticed an increasing weakness of the right hand, especially the extensors ; 
at the end of eight to ten days, could no longer hold the crutch. 

November 4th. — Complete paralysis of distribution of right radial nerve, 
including the triceps ; paresis of median and ulnar nerves ; no notable 
sensory disturbance& Electrical irritability of paralyzed nerves and mas- 
des intact, but no contractions of the extensors upon the forearm can be 
obtained from the supraclavicular point Treatment : An upon the bra- 
chial plexus, Ca labile through the nerve and muscles^ with closures and 
changes of polarity. 

December 5th. — Complete recovery. 

68. Personal observation. ** Sleep" paralysis of the radial nerve. — A 
laborer, aged forty-two years. Slept on his arm the night previously ; no- 
ticed paralysis of hand this morning, with parsesthesise in radial distribu- 
tion to the thumb. Examination shows complete paral3*sis of radial dis- 
tribution to forearm ; triceps intact. Electrical irritability normal, but no 
contractions can be obtained from axilla or supraclavicular fossa. Treat- 
ment : Ca stabile to site of pressure, then to supraclavicular fossa ; Ca also 
applied labile to nerve and muscles. Recovery at the end of a week. 

69. Personal observation, ^^ Sleep" paralysis of the radial nerve. — ^A 
man, aged twenty-five years. September 10, 1872, acquired a paralysis of 
the loft arm during sleep (lay upon the edge of the bed). 

October 11th. — complete paralysis of the neiTe still present The skin 
of thumb and dorsum of hand feels numb, with diminished sensibility. 
Electrical irritability intact ; no contractions in radial distribution can be 
secured from the axilla or supraclavicular region, but this can be done 
readily on right side. Galvanic ti*eatment : immediately afterward patient 
raises his arm to the horizontal. 

October 12th. — Considerable improvement ; faradization. 

October 24th. — Discharged almost cured; all movements cati be executed, 
though not with full power. Patient returned in a week, and after treat- 
ment for another mouth, normal power was restored. 

70. Personal observation. Traumatic paralysis of the radial nerve. — 
March 10, 1881, fracture of arm and forearm. Badial paraksis noted 
after removal of bandage ; marked callus formation in arm. May : radial 
nerve is exposed, found to be thinned in and below the callus, Uiickened 
above. September : complete paralysis of entire radial distiibution in 
forearm ; complete De R ; diminished sensibility on posterior aspect of 
forearm. Slight contracture of the flexors. Galvanic treatment to the site 
of lesion and the muscles from end of September. 

October 13th. — ^Distinct power of motion, though feeble ; sensibility 
improved. Faradic and galvanic excitability of the nerve has retiuned 
above the site of lesion ; De R still present in the muscles. From this 
time on improvement was more rapid. 

71. Personal observation. Combined shoulder-arm paralysis (Erb) from 



SPECIAL ELE0TR0-THEKAPEUTIC8. 218 

if0un/, — A baker, aged thirtj-eigbt years. Fell upon the extended left 
arm and the left shoulder. Impaired power of moving the arm forthwith, 
and numbness of shoulder and upper half of arm. 

July 20, 1867. — Complete paralysis of left deltoid, biceps, and brachialis 
intemus. Complete De B of paralyzed muscles, especially the deltoid. 
GalTanic treatment : An to plexus and cervical cord, Ca labile along the 
paralyzed nerves and muscles. In a few days improvement in flexors of 
forearm, which slowly progressed ; deltoid rapidly atrophied. Patient 
discharged after twenty-two sittings ; biceps and brachialis intemus very 
much improved ; deltoid still completely paralyzed. (Six weeks later spon« 
taneous improvement began in this muscle, with final recovery.) 

72. PerHonal obtservation. Combined shoulder-arm paralysis from neuritis 
of the brachial plexus. — A boy, aged seventeen years. Two months ago 
fleeted with paraesthesia in left thumb and index finger ; diminished sen- 
sation and motion in these fingers ; in two weeks, paralysis of shoulder 
and arm. 

December 1, 1866. — Complete paralysis of deltoid, biceps, brachialis 
intemus and supinator longus, probably also supinator brevis ; paralysis 
in distribution of median nerve to forearm and huid. Electrical examina- 
tion shows partial De It in paralyzed muscles. Galvanic treatment : An 
stabile to the brachial plexus, Ca labile (and with closures) to paralyzed 
nerves and muscles. After the tenth sitting : flexion of forearm normal ; 
flexors of fingers, thenar muscles, and supination very much improved ; the 
deltoid also begins to act Complete recovery after thirty sittiuga 

73. Personal observation. Traumatic paralysis of the radial, median, and 
ulnar nerves, — A soldier, aged thirty-eight years. Wounded August 4, 
1870 ; gunshot fracture of upper third of right arm. 

November 4, 1870. — Complete motor and sensory paralysis of right 
forearm and hand Complete De B in distribution of radial nerve ; ftuu- 
dic and galvanic excitability pretty well retained in ulnar and median dis- 
tribution. Immediately after the first application of galvanism (An to the 
neck, Ca labile peripherally, etc.) sensibility returned to a certain extent 
in the median and ulnar diistribution, and slight movements (which were 
previously impossible) could be performed by the flexors. Rapid improve- 
ment in next few days, and (November 7th) feeble movements appeared in 
radial distribution. The stiflhess of the joints interferes somewhat with 
motion, but improvement made favorable progresa 

The method of electrical treatment of these paralyses depends, in the 
first place, upon the most exact possible diagnosis of the situation and 
character of the lesion causing the paralysis ; when that is known, the ap- 
plication should be made to the site of the lesion : in cerebral paralysis 
the apph'cations should be made to the head and sympathetic (xnde Lec- 
tures XV. and XVL), in spinal paralysis to the cervical cord and sympa- 
thetic {vide Lectures XVIII. and XIX.) ; peripheral paralysis (vide Lec- 
tures XX. ) requires treatment of neuritis, traumatic lesions, affections of 
the shoulder-joint, cicatrices, etc., by the well-known methods. With 
regard to the frequent compression-paralyses of the radial nerve, which 
interfere so much with the use of the hand, I will here make mention of 
R Bemak's statement that the most favorable results are secured in many 



314 BLXCTBO-THBB APEUnCS. 

cases by the stabile application of the Ca ivith a current of modeisie 
strength, and these results are often manifested by the occurrence of in- 
creased mobility during the passage of the current I can confirm this 
statement with regard to some cases^ though only of those which are veij 
mild or have already begun to improve {oide Observation 68) ; as a role^ 
however, I have been unable to detect such an immediate effect. 

Direct antiparalytic treatment must next be applied, and this is often 
very serviceable in peripheral paralyses of the upper extremity. It is not 
infrequently possible to apply the current to the proximal side of the lesion, 
and thus cause an effective breach in the obstruction to conduction. It is 
therefore advisable to attempt this plan in all suitable cases, and to pro- 
duce a vigorous stimulation of the nerve-trunks in the axilla, or still better, 
in the supraclavicular fossa. In order to fulfil all the indications involved 
(direct antiparalytic action, removal of finer and grosser nutritive disturb- 
ances in the nerves and muscles), the nerve-trunks and muscles through- 
out their entire extent should be subjected to vigorous elec^oal excitation, 
according to the well-known methods of local faradization {vide Figa 30 
and 81) ; this holds good with regard to central as well as peripheral par- 
alyses. It is difficult to determine whether any influence is produced bj 
reflex actions, though this is not improbable ; at all events^ in paralysia ol 
mixed nerves, the peripheral stimulation of the n^rve-lnranches and the 
integument will do something toward relieving the obstruction to sensory 
conduction, and very probably may also exert a reflex effect upon the 
motor tracts and the obstruction in them. 

It is lumecessary to enter into a detailed conaideratian of the individ- 
ual forms of paralysis. 

I will state, however, that when contracture of the antagonists is pre- 
sent (as in cerebral hemiplegia, infantile spinal paralysis etc.), and inter- 
feres with the contraction of the paralyzed muscles, it is well to reli^^e 
this by electrical means or mechanically, and then to stimulate the par- 
alyzed muscles. 

It goes without saying that the results of treatment depend upon the 
causes of the paralysis. They are most hvorable in simple oompreasion- 
paralysis, not tmlavorable in severe traumatic paralyses, very good in thoaa 
of neuritic origin, much less favorable in spinal and cerebral paralyaes. 



8. Paralyses of the Lioweb EIxtbbicitt. 

In the lower extremities the conditions with regard to paratysis 
much simpler than in the upper limbs, although it occurs here very fre- 
quently and in manifold combinations, such as isolated paralysis of indi- 
vidual muscles and nerves, combined paralyses up to total paralysis of one 
and very often of both limbs (paraplegia). In the lower extremities th» 



SPECIAL BLEOTBO-THBRAPBUnOS. 21 B 

paraljMS of oentiral origin are of paramount importance, especially iiie 
spinal paralyaea, while cerebral varieties, despite their frequency (in hemi- 
plegia, etc.)» occupy the background because they often improve rapidly, 
and are not felt so severely by the patient 

Almost all diseases of the spinal cord lead to motor weakness or 
nuurked paralysis of the lower limbs (the various forms of myelitis, espe- 
cially acute and chronic poliomyelitis, sclerosis, acute ascending paralysis, 
progressive muscular atrophy, compression and concussion, meningitis, 
eta) ; and almost all these forms are very often the object of electro- 
therapeutic measures. 

The long peripheral course of the nerves, within the spinal canal, in 
the pelvis, and finally along the extremities, gives rise to a great number 
of possible causes of peripheral paralysis ; fractures, dislocations, inflam- 
mation and caries of the vertebree, lesions of the pelvis and pelvic organs, 
mechanical effects of severe inflammations may give rise to paralysis. In 
addition, all possible mechanical and traumatic influences, which affect the 
nerve-trunks in the limbs, inflammatory, exudative, and other processes in 
the large joints are frequent causes of such paralyses ; finally, we must 
mention neuritic affections of these nerves (rheumatic and neuralgic neu- 
ritis, after acute diseases, eta). I will also mention that the lower limbs 
are affected by paralysis in the so-called pseudo-hypertrophy of the mus- 
cles and in the much rarer true muscular hypertrophy. 

It is not my ofiice to enter in detail into a consideration of the 83rmp- 
tomatology of these various forms of paralysis. I will merely state that 
in paralysis of the crural nerve the flexors of the hip-joint (psoas magnus, 
etc.) and the extensors of the leg (quadriceps, etc.) are chiefly affected ; 
this also occurs in an isolated manner in psoas affections and in acute an- 
terior poliomyelitis ; partial paralysis and atrophy of this nerve are alee 
found not infrequently in progressive muscular atrophy, especially the ju- 
venile form. Paralysis of the obturator nerve affects chiefly the move- 
ments of adduction of the thigh, and is, on the whole, quite rare. Paraly- 
sis of the gluteal nerves affects chiefly the movements of abduction and 
rotation, then fixation of the pelvis in walking and standing ; it is most 
frequent in progressive muscular atrophy and pseudo-hypertrophy. Par- 
alysisof the sciatic nerve occurs most frequently, either of the entire trunk 
or its two chief branches ; the peroneal nerve, involving the anterior mus- 
cles of the leg, or the tibial nerve, involving the muscles of the call Al- 
most all spinal paralyses begin in the distribution of this nerve, and iUt 
great length and exposed position also give rise to great frequency of 
peripheral lesions in its course. 

Electrical examination is only available to a limited extent ; this holds 
true especially in determining the exact site of the lesion in peripheral 
paralysis because very large portions of the affected nerves are not acces- 
sible to direct electrical excitation, since they are situated within the pel- 



216 BLECTRO-THER APEUTICa 

Tis or spinal canaL Otherwise the same changes of electrical excitabilitj 
are found in these paralyses as have been described previously, and we 
may draw similar deductions from them, especially vnth regard to the 
severity of the lesion, the secondary trophic disturbances and the prog- 
nosis. You must be cautious, however, in making deductions concerning^ 
the situation of the lesion, as the electrical examination, as a rule, does 
not enable us to determine whether the lesion is of peripheral, spinal, or 
cerebral origin. If De B is present you may, indeed, exclude its cerebral 
origin, but normal excitability may also be observed in spinal diseases ; 
nor can you positively infer the peripheral character of the lesion from 
the presence of De B, as you are aware that this occurs also in very many 
spinal affections. Other symptoms must be taken into consideration in 
making the differentiation ; it should be particularly noted that the pres- 
ence of De B without any sensory disorder or trophic changes in the in- 
tegument indicates quite positively the spinal origin of the paralysi& 
Partial De B is also observed not infrequently in the lower extremities 
(moderate form of 'chronic poliomyelitis, certain peripheral paralyses, pro- 
gressive muscular atrophy, etc.) ; but in true and false muscular hyper- 
trophy and in the juvenile form of progressive muscular atrophy, simple 
diminution of electrical excitability is always found without qualitative 
change. 

I will report merely a few examples of these paralyses and refer you 
to the previously reported Observations 5, 6, 7, 11, 18-22, 82-84, 46, and 
to Observations 82-84, 86-88 which will be described later. 

74. Personal observation. Paresis of the crural nerve (chronic neuritis f). 
— ^A man, aged thirty nine years. Suffering about one and a half years 
from violent pains in the left hip and buttock, extending to the knee ; 
these gradually subsided, and were followed by a feeling of heaviness in 
the limb with marked weakness during the last few months. A month 
ago, after exertion, had severe pain in entire left lower Hmb, especially an- 
terior surface of thigh ; the limb has since grown considerably weaker and 
emaciated. 

April, 1869. — Left thigh distinctly atrophied and flabby ; weakness of 
left quadriceps ; diminished sensibihty on inner, anterior aspect of thigh ; 
electrical excitability slightly diminished. Galvanic treatment : stabile 
currents through the spinal column ; then Ca labile along the nerve and 
muscles and the anaesthetic portion of the integument, the An in the small 
of the back. End of May ; continued marked improvement ; the circum- 
ference of the left thigh has increased one and one-half centimetres; 
power of the limb markedly increased ; numbness almost disappeared. 
Treatment discontinued after sixty-five sittings. 

75. Personal observation, Pareids of the right sciatic nerve ; hypertrophy 
of the calf muscles, — A man a^ed forty-three years. Has been treated twice 
K)r similar affection and rapidly cured by electrical brush ; again returns 
with complaint of weakness in right foot and leg, with coldness and formi- 
cation of foot and calf. 

November, 1873. — Patient drags the right leg ; unable to move the 



SPSOIAL ELBCTRO-THEBAPBUnCS. 217 

right toes. Difitinct paresis of muscles of right calf ; some weakness in 
distribution of peroneal nerve, also in posterior thigh muscles ; crural dis* 
tribution normal. Electrical excitability unchanged. Circumference of 
right calf two centimetres larger than that of left Ghdvanio treatment : 
18 elements labile from small of back through the sciatic nerve ; imme- 
diate improvement After two niore sittings, patient so much reheved 
that he stops treatment 

76. Personal observation. Paralysis in the distribution of the right pero- 
neal nerve (neuritis f). — A woman, aged twenty-six years. Sick since July, 
1866 ; non-appearance of menses, followed by formication and weakness of 
right foot ; dragging of toes. 

May 18, 1867. — Paresis in distribution of right peroneal nerve ; com 
plete paralysis in tibialis anticus alone ; sensibiUty diminished upon entire 
anterior siurface of leg and the dorsum of foot Circumference of right 
leg one centimetre less than that of left. Electrical examination shows 
complete De R in tibialis anticus, simple diminution of excitabiUty in 
other affected muscles. Qalvanic treatment : stabile and labile currents 
through lower part of spine, then Ca labile through the sciatic and pero- 
neal nerves and their muscles. 

July 20th (after eighteen sittings). — Mobility almost normal ; sUght 
diminution of sensibility still present 

77. Personal observation. Paralysis of the left peroneal nerve from the 
cicatrization of a bed-^ore, — A girl, aged nineteen years. During an attack 
of typhoid fever had severe bed-sore over sacrum, which healed after sup- 
purating for months. It was finally noticed that the left leg was par- 
alyzed ; at times, severe pains started from the back, shooting through 
the limb into the peroneal distribution. The patient came imder treat- 
ment three months later. 

June, 1873. — A large deep cicatrix upon the buttocks, deeper and 
firmer on the left side. Almost complete paralysis of entire distribution 
of left peroneal ; sensation normal Circumference of left calf three and 
a half centimetres less than that of right call Complete De B, late 
stage. Qalvanic treatment : 24 elements An and Ca stabile through the 
cicatrix ; then An to the cicatrix, Ca labile through the nerve and 
musdes. 

August 12th — ^The patient was discharged ; improvement has made 
distinct, though slow progress. ExcitabiUty of peroneal nerve has re- 
turned to a sUght extent 

78. •Personal observation. Traumatic paralysis of the left peroneal nerve. 
— ^A man, aged thirty-four years. In a railway accident, December 24, 
1872, the left leg was contused in the popUteal space in the immediate 
neighborhood of the head of the fibula '; immediate paralysis and ansBsthe- 
sia of the left leg and foot (not the sole). 

January 25, 1873. — Complete paralysis of entire distribution of left 
peroneal nerve, weakness of posterior tibial distribution. SensibiUty 
somewhat diminished on dorsum of foot, quite normal in leg. Left calf 
two centimetres smaUer than right Complete De R in peroneal distribu- 
tion ; simple diminution of excitability in tibial distribution. Galvanic 
treatment : stabile with both poles through the site of contusion, then Ca 
labile through the muscles. Traces of mobility returned at end of March, 
first in extensor longus digitorum, then in the peroneal muscles. Im 
provement made steady progress and patient was discharged cured, July 
20ih ; mobiUty good, but power not yet entirely normal 



218 XLBOTOO-THBRAPSTTTIOe. 

The methods of treatment are essentially the same as in the u] 
limb. The causal application must be made to yarious parts, according Id 
the site of the lesion, and special attention must be paid, in this respee^ 
to the treatment of diseases of the spinal cord, articular affections, pe^ 
ripheral nerve lesions, etc., according to the well-known roles. Ito 
especially careful with regard to the proper localization of the c ur re n t 
upon the diseased portions of the spinal cord. 

The further treatment, with direct application of the current to tbe 
paralyzed nerves and muscles, must be made according to general pris- 
ciples ; the possibility of vigorous action above the site of lesion dnks 
into the background, because the plexuses are almost inaccessible to the 
current. In suitable cases, however, you may attempt to stimulate ihe 
nerve-trunks of the cauda equina within the spinal canal by means of vexy 
strong currents and large electrodes (Ca CI and changes of polarity, cads 
page 54) ; or stimulate the sacral plexus in the rectum, which can readify 
be done by a rectal electrode, the other being applied upon or next to 
the sacrum, or upon the point of exit of the sciatic nerve. In all applica- 
tions to the large nerve-trunks of the lower limbs, especially in the upper 
portions, it is advisable to employ large electrodes and relatively stroQg 
currenta The An should be applied to the lumbar region, the Ca to th^ 
nerves and motor points, in such a manner that a large part of the coms 
of the nerve is situated in the track of the most dense portion of the co^ 
rent The crural nerve may be accurately reached in the groin, tbe 
sciatic nerve immediately underneath the gluteus maximus, and the latter 
nerve may be treated labile in its whole course alcmg the posierior aop- 
fiice of the thigh by stroking it vigorously vnth the Ca. In the pof^teai 
space, the peroneal and posterior tibial nerves may be stimulated with 
the greatest facility {vide Fig. 33). In cases in which the nutritive con- 
dition of the muscles requires special consideration you may also reaoii 
to faradic or galvanic excitation of the musdee according to the weU- 
known rules. 

Reflex effects are much more available in the lower extremities than in 
the upper. Numerous reflexes, particularly from the sole and dorsum of 
the foot, the anterior and inner sur&ce of the thigh, the gxoin, may te 
obtained and employed under certain circumstances in the treatment el 
paralysis (according to the general princ^les laid down on page 190). It 
will be rarely necessary to resort to faradic brushing of the integument in 
the positions referred to above ; ordinary faradic or galvanic stimulat^gp 
of the nerve-trunks and labile excitation of the skin with moist electarodea 
will suffice for this purpose. 

As a matter of course the results of electrical treatment depend chiefy 
upon the causes of paralysis. The prognosis is very poor in severe spinal 
diseases, but good results are often obtained in chronic anterior poliomyel- 
itis, in traumatic, neuritic, arthritic, rheumatic, and compression-paralysis. 



LEOTUEE XXIV. 

BUotKO-therapentios dt IndiTidaal FormB of Para) jsis (oonoliuioii)— 9. Pacaljdia «! 
the Yelam PaUti and Pharynx ; Paral^ysis of DeglnUtion : Pathogeneaiii ; Caaes ; 
Methods of Treatment— 10. Paralysis of the Laryngeal Muscles; Paralysis ot the 
Vooal Cords : Character and Methods of Treatment ; Perontaneons and Endo- 
laryngeal Application ; Besolcs— 11. Paralysis of Respiration : Artificial Baapira- 
tion; Rhythmical Faradization of the Phrenics— 12. Diphtheritic Paralysia: 
Pathogenesis and Symptoms ; Cases ; Blectrioal Treatment ; GalTanisation of the 
Heart; Results— 13. Lead Palsy aod other Toxic Paralyses: Gharaoteristica <|f 
Lead PiO^ ; Electrical Bxoitability ; Situation and Character of the Disorder ; 
Me^od of Treatment— 14. Muscular Atrophy and Qypertrophy: Purely Mnaoa* 
lar Atrophy; Atrophy in Articular AfifectionB; Oeaea; Txeataent; Mnsnnlw 
Btjpariropl^ ; Congenital Myotoniik 



9. PaftALTnB OF THs YsLUM Palati and PHAsmz; Pabaltob of Dach 

LUTITION. 

Pabalxhis of the velum palati is oharaoterized by naaai. q>eeoli, diflt- 
mdty in the proniinoiation of certain letters, disturbanoe of deglatitioB 
and regurgitation of fluids through the nose, and is recognized on inspepK 
tion by immobility during phonation and abnormal position of the Teluni 
palati and uvula, and also by the absence of reflex movements on touching 
these parts; it may be unilateral or bilateral, confined to individual 
muscles (mt diffused over alL It is often a part-symptom of paralysis of 
tile &cial nerve (at the base of the skull) or the trigeminus, or a sequeji^ 
of diphtheria^ or a symptom of bulbar paralyses, occasionally of cerefan4 
hemiplegias. 

Paralysis of deglutition, from paresis and paralysis of the pharyngeal 
constrictors, is sometimes a part-symptom of cerebral paralysis, but is 
most frequently either a sequela of pharyngeal diphtheria or a symptoi^ 
of bulbar paralysis. It is characterized by difficulty or impossibilii^ of 
deglutition, by the fact that food *' goes the wrong way," and by the ab> 
sence of vigorous reflex contractions upon mechajiical irritation of th» 
walls of the pharynx. 

As a rule, it is not difficult to recognize these disturbances, but it ifi| 
often difficult or impossible to determine the degree of implication of the 
individual muscles or nerve-branches. 



220 ELBCTBO-THEBAPEUTIGS. 

Nor does electrical examination famish much information in this 
gaid, since isolated excitation of the individual muscles can be imperfecta 
performed. In some cases nothing abnormal has been found ; in others^ 
simple diminution of excitability (bulbar paralysis) ; in others De R (for 
example, in diphtheria, in which it was first observed by Ziemssen). Not 
many attempts have been made to examine the pharyngeal muscles directly 
with electricity ; on the other hand, the reflex development of movements 
of deglutition {vide page 55) may be difficult or impossible in paralysis of 
deglutition, so that very strong currents become requisite (in progressive 
bulbar paralysis). 

A few observations may serve as illustrations of the treatment and its 
results: 

79. Personal observation. Paresis of the velum palaiL — A girl, aged 
seven years. Had presented symptoms of the disease from early childhood : 
nasal twang in speaking, and inability to pronounce certain letters, espe- 
cially 8, c, X, etc., because the air escaped through the nose, and the s 
sounded very much like n. Examination showed slight paresis of the 
velum palati ; while drinking, fluid occasionally escapes through the nose. 
Child never had diphtheria ; is well otherwise. Treatment : ^vanic cur- 
rent transversely through the anterior auricular region and longitudinally 
from the back of the neck to the cheeks and the floor of the mouth ; slow 
improvement. Later, direct faradization of the velum palati, and system- 
atic exercise in the pronunciation of the s sound. Cured in about fifty 
sittinga 

80. Observation by M, Rosenthal. Diphtheritic paralysis of the vdum 
palati, the tensor of the choroid, and the sphincter of the pupil — A girl, aged 
twenty-two years. Had diphtheria ; suflering from difficiidty in deglutition, 
frequent regurgitation of fluids ; indistinct, nasal speech ; paresis of the 
right half of the velum palati. Paresis of accommodation ; right pupil 
dilated, and reacts poorly. Velum palati and pharyngeal reflexes markedly 
diminished ; electrical examination showed De R Local galvanic treat- 
ment of the velum and the production of movements of deglutition cured 
the nasal speech and the disturbances of deglutition within a week. 

81. Personal observation. Diphtheritic paralysis. — A man, aged twenty- 
five years. Had diphtheria from June 29 to July 12, 1867. A few days 
later, renewed difficulty in deglutition, but without pain ; regurgitation of 
fluids through the nose. Some weakness and tremor in the limbs ; dimin- 
ished power of vision ; difficult, slightly nasal speech. 

July 18th. — Mobility of velum during phonation tolerably good, but 
slightly defective on the right side ; sensibility very markedly diminished ; 
reflex excitability entirely absent Distinct diminution of faradic and gal- 
vanic excitability of the muscles of the velum palatL In drinking, fluids 
enter the nose, deglutition disturbed. Sight not so good, especially for 
distance ; pupils difler slightly, and react slowly. Galvanic treatment 
transverely through the cheeks, cervical sympathetic, and direct application 
of the Ca to the velum palati. 

September 2d (after eighteen sittings). — ^Patient discharged in a toler- 
ably good condition. 

Also see Observations 16 and 17 (difficulty of deglutition as a result of 
bulbar diseases). 



SPECIAL XLBCTBO-TUBBAPEUnCS. 231 

The method of treatment of tbeae paralTses should be selected with 
re^^ard to the causal lesioD, i.e., the applications suitable to bulbar and 
cerebral diseases, to paralysia of the bcial nerve, etc. ; in diphtheritio 
paralyses the stabUe galvanic current should be 
paased, for a few minutes, transreraely through 
the region of the velum palati and pharynx (trans- 
Tersely through the cheeks in front of the ear or 
through the auriculo-mastoid fossfe). 

In paralysis of the velum palati we may also 
employ direct faradization or galvanization, 1^ 
which contraction of the paralyzed muBcIea will 
be produced in a direct as well as a reflex man- 
ner. The electrode should be catheter-shaped, 
insulated to the tip, which should be small and 
round, and covered with fine sponge or chamois ; 
it is well to have an interrupting handle (Fig. 
39). The tip of the electrode is appUed to the 
various parts, the mouth being kept wide open, 
and deep respirations taken through the mouth ; 
the current should be sufficiently strong to pro- 
dooe distinct contractions in the tongue or the 
muscles of the Upe, if they cannot be produced 
in the velum itself. The anode is applied to the 
neck, the duration of the apphcation being one to 
three minutes. 

In paralyms of deglutition the same electrode 
may be emph)yed to produce direct and reflex con- 
tractions of the pharyngeal muscles. But this 
method is somewhat inconvenient, and it is there- 
fore better to employ the method, previously de- 
scribed (pi^e 66), of producing reflex movements 
of deputation from the neck. Stronger currents 
are required than in healthy individuals, and the 
strength should therefore be increased until Ca 
CI or labile apphcation of the Ca is followed by 
a distinctly visible or audible movement of deglu- 
tition. About ten of these movements should be mi|nai'aii»toidii,tn<niiue>iii>uiB 
produced at each sitting. As the muscles are " '*™"^°"'™^'^ 

easily exhausted in bulbar paralysis, it is advisable, in this affection, to 
allow an interval of a few seconds to elapse between the individual acts of 
deglutition. 

The results of treatment depend mainly upon the primary cause of the 
disease ; they are, at the most, palliative in bulbar paralyses, but so much 
more brilliant in other fcoma, especially diphtheritic paralyses. 



mS XLSOTBO-THSBAPXUnOS. 



10. Pabaltbd of ths liABYiroxAL Mttsoub; PABALTOBOt tSB YooAi. Ccnn; 

Pabalytio Aphonu akd Dtspbohia. 

More recent studies in laiyngology have disdosed the great freqneiioj 
of paralytic conditions in the huTngeal muscles, which may be eittier ihv 
lated or yariously combined. 

As a matter of course, the situation of the cause of paralysis is oi prime 
importance with regard to the therapeutic measures — whether in the laryn- 
geal muscles or the most adjacent motor nerve branches (in catarrh, ulcer- 
ation, new formations, cold, OTer-exertion) ; or in the laryngeal nerres, 
which may be a£fected in yarious ways (diphtheria, neuritis, compreaBion 
by tumors, scrofulous growths, aneurisms, injuries, operations, cioatrices, 
etc) ; or in the trunk and roots of the pneumogastric or spinal aocesscny 
(diseases of the vertebrsa, tumors at the base of the skull, or in the neok) ; 
or, finally, in the central organ itself (bulbar paralysis, hemcHrrhage into 
the medulla oblongata, pons yarolii, or other parts of the brain, etc). In 
some cases, especially in hysterical paralyses, in the rare toxic and inter- 
mittent paralyses of the Tocal cords, we are entirely in the dark with re- 
gard to the site of the lesion. 

With respect to the symptomatology, I will state that lesion of the 
superior laryngeal nerve causes paralysis of the muscles of the epiglottis, 
insufficient closure of the glottis, paralysis of the crico-thyroid muscle, and 
anffisthesia of the upper half of the larynx, while a lesion of the inferior 
laryngeal nerve causes paralysis of all the other laryngeal musdes, and 
anaesthesia of the lower half of the larynx. This paralysis may be unilat- 
lateral or bilateral, involving the entire nerve or individual nerves or mus- 
des. Most frequent and important is the lihilateral total paralysis of the 
recurrent laryngeal and, among the isolated muscular paralyses, bilateral 
paralysis of the arytenoideus posticus, and the veiy frequent paralysiB of 
the internal thyro-arytenoid muscles, the musdes proper of the vocal 
cords. Further details may be found in the text-books on laryngology. 

Electrical examination of the laryngeal musdes and nerves is not prac- 
ticable in the majority of cases. Ziemssen states that he has succeeded in 
testing the electrical excitability in very rare cases, and that he has found 
normal as well as diminished excitability, and also the De R. 

The first point of application in the treatment will depend upon the 
site of the lesion (transversely through the mastoid processes, through the 
brain, cervical cord, etc., application of one or both poles upon sites of 
compression, cicatrices, neuritis, etc., in the peripheral course of the 
nerves). But this is usually insufficient, especially since, in many cases, 
we are entirely in the dark with regard to the real situation of the lesion. 
It is then proper to apply the direct antiparalytic e£RBct of the dectrical 
current to the entire nervous and muscular apparatus of the larynx. 



SPECIAL ELEOTBO-THBBAPEUTICS. 228 

I may reoommend percutaneooB exxdtation of the larynx an^ all its 
mftrres as a method whioh should be tried in all oases, either with ttie gal- 
vanic or faradic current In employing the former, the An is placed Idgh 
Up in the neck (in order to be as near as possible to the origin of the 
pneumogastric and spinal accessory nerves) while the Ca ("small" or 
'* medium " electrode) is stroked lalnle from the angle of the lower jaw 
idong the larynx and trachea and in dose proximity to them, or repeated 
isathodal closures may be made over all th^e various parts, both laterally 
and anteriorly ; this is done from one to two minutes on both sides. The 
pneumogastric, inferior, and superior laryngeal nerves are thus brought 
within the range of the densest part of the current If you desire further 
to stimulate the larynx vigorously, apply " medium *' electrodes on each 
lateral surface and make repeated closures and changes of polarity. From 
eight to twelve elements will usually be entirely sufficient for this purpose. 

With the feradio current the same method of application is employed, 
the An in the neck, the Ca (''small" or "fine" electrode) at the angle of 
&e lower jaw, at the side of the larynx below the comer of the hyoid bone 
(superior laryngeal nerve), then pressed deeply along the side of the tra- 
chea more inferiorly (inferior laryngeal nerve), finally upon the larynx 
itself and transversely through it with very strong current& 

There is no doubt that vigorous stimulation of the nerves is possible 
in this manner. 

But if this method does not produce the desired result, you may em- 
ploy endolaryngeal or more properly endopharyngeal electrization. The 
previously mentioned laryngeal electrode is used, or one of Ziemssen'e 
double electrodes which admits the introduction of both poles into the 
pharynx. The strength of the current should be such that distinct con- 
tractions are produced in the frontal muscle by faradic or galvanic excita- 
tion of its nerve. In unipolar excitation the indifferent electrode is placed 
upon the back of the neck. The circuit is not closed until the electrode 
is placed in the required position ; its action must usually be restricted 
to a few seconds in each position. 

The following are the chief motor points : superior laryngeal nerve — 
electrode in the pyriform sinus, pressed somewhat against its anterior wall 
by raising the handle ; transverse arytenoid muscle — electrode upon the 
posterior surface of the arytenoid cartilages ; lateral crico-ar3rtenoid muscle 
— deep in the pyriform sinus posteriorly and inferiorly ; external and in- 
ternal thyro-arytenoid muscles — same as before, but the tip of the elec- 
trode pressed downward, inward, and forward ; posterior crico-arytenoid 
muscle — electrode upon the posterior surface of the arytenoid cartilage 
and laterally behind the cricoid cartilage ; thyroepiglottic and aryepi- 
glottic muscles — upon the lateral parts of the base of the epiglottis. 

This form of treatment meets in practice with the greatest difficulties. 
Great skill and experience are requisite before treatment can be begun 



234 BLSOTBO-THXBAPSUnoeL 

and each applioation is followed by gagging, vomiting, iemporaiy aphonii, 
hoarseness, pain in the neck, etc^ so that this plan should only be adopted 
if the percutaneous method has failed. 

Whether the admirable results obtained by Moritz Meyer in hjstericai 
and other forms of vocal cord paralysis by the application of the feumUe 
moxa (vigorous stimulation with a stationary brush) are secured in a reflex 
manner alone, can not be determined with certainty, since he applies the 
brush to the integument covering the larynx itself and in this manner the 
current may enter the organ. Meyer has seen frequent recoveries after 
one sitting. 

The therapeutic results in these paralyses are usually most striking in 
so-called hysterical aphonia— the voice is often restored in a few minutes, 
after it had been extinguished for weeks or montha As a rule, however, 
the recovery is not persistent In catarrhal and rheumatic paralyses, and 
in those forms due to over-exertion, the prognosis is also very good, es- 
pecially in those cases in which true paralysis is not present but merely 
"atony of the vocal cords" (Oerhardt). In the remaining forms the re- 
sult depends upon the character and severiiy of the lesion. 



11. RESPm/iTOBT Pabaltsbs ; Asphyxia ; Abtifioial RsspmATioir. 

For the sake of completeness I will refer to certain cases of paralysis 
of the respiratory function, which are due, in great part, to inexcitabOity 
of the respiratory centres and are known under the terms trance and as- 
phyxia. The electrical current is sometimes serviceable under such con- 
ditions. 

I do not refer to the possible effects of the current upon the centres 
themselves, but rather to the production of artificial respiration, by means 
of which life may be prolonged until the respiratory centres again resume 
their independent automatic function and respiration occurs spontaneously. 
This can be done very readily and continued for a long time without any 
injurious effects. 

Artificial respiration may be effected by rhythmical faradization of the 
phrenic nerves and other nerves in their vicinity ; as in asphyxia from 
coal gas, illuminating gas, chloroform or opium, also in profound intoxi- 
cation, in the trance of drunken and frozen individuals, or of the new-bom. 

I have previously (page 124) given a short description of the method of 
application ; I will add that the An should not be placed too low upon the 
abdomen and should be as large as possible, in order that the inspiratory 
descent of the diaphragm be not interfered with by the contraction of the 
abdominal muscles. If you have stimulated the parts for some time and 
the respirations occur regularly, you should allow an interval to elapse in 
order to observe whether respirations will not occur spontaneously ; if this 



SPECIAL ELEOTBO-THEBAPBUTICS. 225 

is not the case, artificial respiration should be performed again, and in 
this manner it maj be continued for a number of hours, even for a day or 
more. 

Whether it is not well to alternate galvanic excitation occasionally 
with the faradic, or to attempt to increase the excitability of the respira- 
tory centres by the occasional passage of a vigorous galvanic current 
through the cervical cord and medulla oblongata, I will leave imdecided, 
as I have had no personal experience in these conditions. 



12. DiPHTHEBino Paralysis. 

As the result of diphtheria, either of the pharynx or of other parts of 
the body, paralyses occur not infrequently ; these may be located in various 
portions of the body and are characterized in a veiy striking manner by 
the peculiarity of their localization and the consequent combination of 
paralyses. They generally begin one or more weeks after the cessation of 
the diphtheritic process and gradually advance, sometimes even to a fatal 
termination. 

The earliest and most constant affection is that of the velum palati and 
pharyngeal structures, and is evidenced by the nasal speech, disturbance 
of deglutition, regurgitation through the nose, defective closure of the 
larynx, and anaesthesia of the parts with absence of reflex action. Paresis 
and paralysis of the external and internal ocular muscles (mydriasis, paraly- 
sis of accommodation) are not infrequent ; also disturbances of the heart's 
action, strikingly slow or accelerated pulse, cardiac weakness progressing 
to cardiac failure ; furthermore, paresis and paralysis of all possible 
muscles of the trunk and limbs, with or without sensory disturbance, not 
infrequently with atrophy and various anomalies of electrical excitability, 
and occasionally weakness of the sphincters; finally, a form of ataxia 
which reproduces more or less completely the symptomatology of tabes 
dorsalis (aniesthesia, parsesthesia, absence of tendon reflexes, etc.) but is 
usually accompanied with distinct paresis, chiefly in the lower limbs. 

A series of recent anatomical investigations have given us information 
with regard to the character and localization of these varied paralytic symp- 
toms ; they include hemorrhages, inflammations, and degenerations in all 
possible parts of the central as well as peripheral nervous system (intersti- 
tial and parenchymatous neuritis in the peripheral nerves and spinal nerve 
roots, meningitic and myelitic changes, especially anterior poliomyelitis, 
hemorrhages into the brain, spinal cord, and peripheral nerves, etc.) — pro- 
cesses which take a favorable or unfavorable course according to their 
localization and intensity. 

Electrical examination also affords correspondingly variable results: 
the excitability of the paralyzed nerves and muscles is often found un^ 
15 



226 ELBOTBO-THEBAPSUTIGS. 

changed, sometimes simply diminished, and not infrequentlj De B is pre- 
sent The latter has been observed most frequently in the paralyzed palat- 
al muscles but may also be present in diphtheritic paralyses of the face 
and extremities. I will now furnish a few illustrations {vide also Obser- 
vations 80 and 81). 

82. Personal observation. Diphtheritic paralysis ; ataxia, — A student, 
aged twenty-two years, had diphtheria in August, 1879 ; a few weeks later, 
difficulty in deglutition, then weakness and uncertainty of the limbs, parses- 
thesia and anesthesia of the hands, slow action of the heart. End of 
October, 1879 ; difficulty in deglutition from paresis of the muscles of the 
velum palati ; pupils tolerably wide, with fair reaction, sUght insufficiency 
of the internal recti ; slow action of the heart, pulse sixty ; distinct ataxia 
of the arms, numbness and anaesthesia of the hands ; a somewhat uncer- 
tain gait, sUght ataxia and distinct weakness in the peroneal distribution ; 
while standing can not elevate the tips of the toes ; electrical excitability 
distinctly diminished ; sensibility of the legs good, cutaneous reflexes nor- 
mal, patellar tendon reflexes normal Galvanic treatment of sympathetic, 
spin£d cord, and peripheral nerves and muscles with very good results, and 

Eatient had quite recovered at beginning of December, 1879 ; walks for 
ours without difficulty, no weakness in peroneal disixibution ; patellar 
tendon reflexes vigorous. 

83. Personal observation. Diphtheritic paralysis ; ataxia. — A girl, aged 
nine years. Had severe diphtheria in beginning of October, 1876. ^End 
of October, paresis of accommodation, insufficiency of the internal recti, 
pupils normal ; paralysis of the velum palati from which no reflex action 
can be obtained. Gsdvanic applications transversely through the mastoid 
processes and from the neck to the eyes. Insufficiency of internal recti 
cJmost disappeared by November 7th. Feebleness and uncertainty of the 
legs now developed, with continually increasing ataxia of all the limbs 
and para^sthesia ; entire absence of patellar tendon reflexes. Despite gal- 
vanization of the spine and the sympathetic, the disease made further 
progress and distinct motor paresis made its appearance, chiefly in the 
upper Hmbs but also in the left facial nerve and in the legs ; no diminu- 
tion of sensibility. At the end of November, 1876, the disease reached its 
acme and then began to improve slowly ; the mobility of the velum palati 
first returned, then the gait improved and the ataxia of the legs disap- 
peared ; finally the ataxia of the upper limbs also diminished. 

February 1, 1877. — The patient was discharged almost entirely well, 
but the tendon reflexes were still absent and did not return until four 
weeks later. Complete recovery. 

84. Observation by R. Schulz. Diphtheritic paralysis ; ataxia. — A boy, 
aged eighteen years. Had diphtheria during Easter, 1877. Two weeks 
after recovery he observed a disturbance of vision, nasal speech, and diffi- 
culty in deglutition ; then increasing weakness in the arms and legs, 
numbness of the soles of the feet. 

Middle of July, 1877. — Pupils normal, vision poor for remote and near 
objects, paresis of the right internal rectus ; speech very nasal and stut- 
tering. Paralysis of the velum palati ; distinct paresis of the limbs, es- 
pecially on the right side ; cutaneous and muscular sensibility intact ; dis- 
tinct but slight ataxia of the arms and legs, absence of the patellar tendon 
reflexes. The large nerve-trunks and the sympathetic are tender on press- 



SPECIAL ELEOTRO-THERAPEUTICa 227 

nre. Electrical examination shows moderate diminution in the individual 
nerve-trunks, but no De R. Galvanic treatment transversely through the 
mastoid processes, from the neck to the eyes ; galvanization of the spine, 
direct treatment of the limbs and velum palati vnth the Ca labile. Paresis 
of accommodation improved after six sittings, and paralysis of internal 
rectiis and of the velum palati completely relieved after twenty sittings ; 
paresis and ataxia of the limbs relieved in a few further sittings. The 
patellar reflexes were still absent when the patient was discharged. 

85. Personal observation. Diphtheritic paralysis. — A girl, aged twenty- 
two years. Had diphtheria of the pharynx seven weeks previously, soon 
followed by distinct weakness of the voice, which constantly increased ; 
then difficulty of deglutition with regurgitation of fluids through the 
nose. For past mon&, feeble vision, especially for near objects. For the 
past week, formication in hands and feet. Status : nasal speech ; very 
feeble, somewhat hoarse voice, paresis of left vocal cord ; paresis of ac- 
commodation, slow pupillary movements ; marked paresis of left half of 
velum palati, less of the right ; anaesthesia of these parts with loss of re- 
flex action. No objective disturbance of motion or sensation in the limbs. 
Electrical examination showed marked De B in the velum palati. Gal- 
vanic treatment transversely through the mastoid processes, cervical 
sympathetic, and spinal cord ; direct treatment of the velum palati with the 
Oa labile. After ten sittings, velum palati very much better, sight some- 
what improved. Very slow progress of improvement, so that patient was 
not discharged in a satisfactory condition until after forty dally sittings. 
At a later period, complete recovery ensued. 

The method of electrical treatment of diphtheritic paralyses presents 
no peculiarity, but a certain manifold character on account of the numer- 
ous localizations with which we have to deal According to general prin- 
ciples, the site of the lesion must first be determined — whether in the 
muscles and peripheral nerves, in the roots of the spinal nerves, or in the 
spinal cord and brain — and the choice of the method of application deter- 
mined accordingly. In other respects the direct treatment of paralysis of 
the ocular muscles, of deglutition, the diaphragm and the extremities 
should be made in exactly the same manner as I have previously described. 

In the treatment of weakness of the heart — which, as it seems, may be 
efi^Bcte^ either through the e^citomotor paths or the pneumogastric nerve 
— electricity may also be employed provisionally. Ziemssen found in a 
patient in whom the anterior wall of the thorax had been removed by an 
operation and a large part of the heart exposed (covered by the integu- 
ment alone) that it was possible by means of strong galvanic currents to 
exercise a direct influence upon the vigor and form of the contractions, 
and also upon the frequency and rhythm of the heart-beats, i.e., a direct 
stimulating action upon the motor ganglionic apparatus of the heart. He 
found that regular and frequent interruptions of strong currents increased 
the normal frequency of the beats, and also that such an increase could 
be produced by the action of a strong, iminterrupted current upon .certain 
parts of the surface of the ventriclea On the other hand a retardation of 



238 ELECTBO-THEBAPEUnCS. 

the heart's action could not be secured with the same certainty and rego- 
laritj. Similar results can also be obtained when the thoracic walls are 
intact The method is : the use of large electrodes, one applied to the 
cardiac region, the other to the dorsal vertebrse, and then a current of 
great intensity applied with frequent changes of polarity (seventy to eighty 
l)er minute). 

In diphtheritic heart failure we may also recommend galvanization of 
the cervical cord and the medulla oblongata and irritation of the pneumo- 
gastric and sympathetic in the neck in a manner similar. to that described 
in the treatment of the larynx (page 223). 

The results of electrical treatment in diphtheritic paralysis are, on the 
whole, very favorable, but sometimes we are imable, despite every effort^ 
to prevent the progress of the paralysis and the fatal termination. Under 
all circumstances, however, we must expect treatment to be continued for 
weeks, and often for months, before recovery occurs. 

Similar principles govern the treatment of other paralyses after acute 
diseases (typhoid fever, cholera, dysentery, acute exanthemata, especially 
small-pox, puerperal fever, intermittent fever, etc.). In these forms, also, 
we have to deal with a varied pathogenesis and localization (peripheral, 
spinal, or cerebral), with severe or slight lesions and all their conse- 
quences and symptoms. The electrical treatment depends upon the cir- 
cumstances surrounding each case. 



13. Lead Palst and othsb Toxio Pabaltses. 

The electro-therapeutist is brought in contact very frequently with 
paralyses due to chronic lead poisoning and these are very interesting in 
many respects. As they interfere greatly with the patient's usefulness, 
they present no slight practical importance. 

As a rule, paralysis is not one of the early manifestations of lead pois- 
oning ; it is usually preceded by other symptoms, especially repeated at- 
tacks of colic. At all events the patients must have been subjected for a 
long time to the deleterious action of the lead. 

Lead palsy occurs most frequently in a perfectly distinct and typical 
form as extensor pai*alysis of one or both forearms, the extensor communis 
digitorum being first affected, then the extensors of the wrist, the long 
muscles of the thumb, etc., while the supinators — and this distinguishes 
it from the majority of radial paralyses — escape, the supinator brevis for a 
long time, the supinator longus permanently, as a rule ; the tricepsalways 
remains intact. 

The development of the paralysis generally occurs veiy gradually, 
spreading from one bimdle of the extensor digitorum to the other mus- 
des ; distinct atrophy is soon noticeable, together with constant De B, 



SPECIAL BLEOTBO-THBBAPEUnCS. 229 

though in a somewhat modified form, corresponding to the pecnUar man- 
ner of development of the paralysis. Sensibility always remains entirely 
intact The affection usually spreads to both arms in rapid succession. 

This is the ordinary and very characteristic history, but other localiza- 
tions may occur occasionally. Thus R Remak has found that the often- 
mentioned group of muscles (deltoid, flexors of the forearm, supinators, in- 
fraspinatus) are occasionally implicated to a predominant extent (arm 
type) so that my " combined shoulder-arm paralysis '* may also be pro- 
duced by lead poisoning. It is found not infrequently that other muscles 
are also affected, that it spreads to the small muscles of the hand in the 
median distribution, to the ulnar distribution, the deltoid, etc., and this 
may lead finaUy to general lead paralysis, in which the dorsal muscles, 
diaphragm, lower limbs (the latter not infrequently in a typical manner, 
with atrophy and De B) are impUcated. 

Electrical examination shows that De B is a constant phenomenon in 
lead palsy. Its development keeps pace vnth the paralysis ; if the latter 
occurs rapidly, complete De B will be developed ; if it occurs slowly, the 
stage of increased galvanic excitability falls into the background, and the 
characteristic quaUtative anomahes alone remain distinct (slow contrac- 
tion. An CI C > Ca CI C, increased mechanical excitabiUiy). Lead par- 
alysis has also presented those remarkable instances of isolated galvanic 
De B in muscles which are not paralyzed or whose motor power is scarcely 
at all interfered with, apart from the fact that partial De B is occasion- 
ally presented. The long continuance of lead palsy and the not infre- 
quent relapses, may compUcate the conditions of electrical excitability in 
a marked degree. 

The De B does not always affect all the muscles impUcated in lead 
palsy ; many escape and present either a simple, moderate diiAinution of 
electrical excitabihty or no change whatever. 

This fact is decisive with regard to the prognosis, as the muscles which 
do not present the De B usually return to the normal in a short period, 
while the restoration of the others ordinarily occupies a very long time. 
The existence of the De B enables us to draw a positive conclusion con- 
cerning the presence of degenerative atrophy, and, at the same time, de- 
cidedly favors the theory of a neurotic as opposed to a myopathic origin, 
and, together with the complete integrity of sensibihty, points to a spinal 
origin of the paralysis (at least in the anterior roots of the nerves). 

Nevertheless, despite numerous recent investigations, the question with 
regard to the nature and localization of lead palsy is still unsettled. It ap- 
pears, indeed, to be positively determined that it is not situated primarily 
in the muscles but is of neurotic origin ; but whether the primary lesion 
must be sought in the peripheral nerves (and in their motor fibres alone) 
or in the anterior gray columns of the spinal cord has not been definitely 
ascertained. The more recent observations, which have shown a paren- 



230 ELEOTBO-THKBAPEUnOS. 

chjmatous degeneration of the peripheral nerves and negatiTe appearanoas 
in the spinal cord, favor the view of a peripheral lesion. NevertheleaB I 
can not regard it as positively proven that the spinal cord is not primarily 
diseased. What can be proven by the negative results of examination 
with our present defective microscopical methods ? Gross lesions can not 
be looked for in a toxic process which usually recovers in a short time, 
and the function of the anterior gray columns and their ganglion cells 
may be very markedly disturbed, although no change can be demonstrated 
microscopically ! And this disturbed function may produce degenerative 
atrophy of the peripheral nerves as readily as a primary a£fecti<m of these 
tracts. 

The weight of clinical evidence appears to me so predominant that I 
still adhere, for the present, to the theory of the spinal origin of lead 
paralysis, t.e, to the assumption of a primary change in the anterior gray 
columns. 

Electrical treatment must be directed first to the site of the lesion ; in 
the present unsettled state of the question, I think it well, ior two reaeons, 
to treat the cervical enlargement of the cord. 

In the first place, because I regard this as the most probable site of the 
lesion, and, in the second place, because I assume that an application of 
electricity to the trophic centres in this region may not be devoid of favor- 
able action upon the degeneration of the peripheral nerves (and musdes). 
First apply a broad {'* large ") electrode, which covers the entire oervical 
enlargement, upon the lower cervical and upper dorsal vertebra, the 
other electrode upon the sternum, and then permit the stabile action of a 
vigorous current, first the An, then the Ca, for one or two minutes. The 
form of galvanization of the sympathetic recommended by the elder 
Bemak mtfjr also be employed, though it probably acts in consequence of 
the simtdtaneous effect upon the cervical cord. Then apply the ordinary 
methods of peripheral treatment to the radial distributicm (or any other 
neuromuscular tracts which may be a£fected), the An remaining upon the 
cervical enlargement. A few minutes' vigorous labile excitation are sufii- 
cient (if the excitability of the muscles is very much reduced, the direct 
application of both electrodes upon the muscles and changes of polarity 
may become necessary). 

As a matter of course the galvanic current is mainly indicated on ao- 
count of the degenerative atrophy, but the ripe experience of Duchenne, 
Moritz Meyer, and others proves that the faradic current is not useless ; in 
all probability, it acts chiefly in a reflex manner. 

The results of treatment are usually very satisfactory, but we must 
persevere for many weeks and months. The majority of oases recovw, 
but many old cases, especially those in which the paralysis is generalised, 
remain incurable. 

Other toxic paralyses very rarely come under treatment; they huw 



SPEOIAL ELSCTRO-THEBAPEUTICS. 2&1 

been obsenred as the resolt of copper, mercury, zinc, most frequently ol 
chronic arsenic poisoning. Arsenic paralysis occurs as a more or less dif- 
fuse, sometimes generalized paralysis of the limbs, with rapidly progres- 
sive atrophy and simple diminution of electrical excitability without De B 
(Seeligmu^er). Its electrical treatment follows general principlea 



14. MusouLAB Atbofht and Htfebtbopht. 

It now remains for me te say a few words with regard to the electrical 
treatment of yarious forms of muscular atrophy and hypertrophy. 

I have spoken, with sufficient detail, of those varieties which are part- 
symptoms and sequelae of different peripheral and central paralyses, and 
their treatment is pursued according to the general piinciples laid down 
on page 192. This forms part of the treatment of poliomyelitis, amyo- 
trophic lateral sclerosis, progressive muscular atrophy, bulbar paralysis, 
peripheral, rheimiatic, traumatic, neuritic paralyses, lead palsy, etc. 

But there are other, so to speak idiopathic or pure muscular atrophies ; 
among these I include those produced by disuse, prolonged rest in bed 
and inaction, pressure of bandages, ankylosis of the joints, etc., and per- 
haps a part of those included under the general head of progressive 
muscular atrophy, especially, the ''juvenile form," belong in this cate- 
gory, but particularly those extremely frequent cases of muscular atrophy 
which follow acute and chronic inflammations of the joints. Their patho- 
genesis is by no means clear ; in a very small fraction of the cases we 
have to deal with a myositis which has spread from the articular inflam- 
mation ; in individual cases, perhaps with a neuritis which has led to 
paralysis of the affected muscles and secondary atrophy. But as a rule 
nothing of this sort can be demonstrated, and a rapidly progressive sim- 
ple atrophy occurs with corresponding weakness and paresis of the mus- 
cles, which may perhaps be attributed to reflex spinal nutrition-inhibiting 
influences starting from the articular irritation. 

These forms of muscular atrophy are especially frequent and important 
in diseases of the shoulder and knee-joints, and they then affect mainly 
the deltoid and quadiiceps, more rarely the peroneal distribution ; in hip- 
joint affections I have also observed this on various occasions in the mus- 
cles of the hip, buttocks, and thighs. The atrophy may be very pro- 
nounced, with more or less marked paresis, perhaps finally paralysis, and 
is associated occasionally with pain. 

It is a characteristic feature that De B is never present in such cases 
(unless a neuritic paralysis happens to be present), but that the electrical 
excitability merely shows a simple, more or less marked diminution, but 
never any quahtative changes. This form of atrophy is thus sufficiently 
distinguished from neurotic, degenerative atrophy. 



232 £LECTK0-THBRAP£UT1CS. 

86. Personal observation. Paralysis and atrophy of the quadriceps in 
consequence of inflammation of the knee-joint, — A woman, aged twenty-fiTe 
years. Had a violent and very obstinate inflammation of the knee-joint a 
year ago ; free from pain only during last month ; has since notic^ that 
the leg is heavy and immovable, and cannot be advanced properly in vralk- 
ing. Status : right knee-joint somewhat thickened but painless, moTe- 
ments free. Complete paralysis of anterior muscles of thigh; the leg 
cannot be moved out of the vertical position, nor the limb bent at the 
hip. Considerable atrophy of the muscles ; electrical excitability simply di- 
minished without qualitative change. Sciatic distribution normal Gkd- 
vanic treatment directly to the muscles with changes of polarity ; one 
electrode in the gi'oin. Immediately thereafter the leg could be extended 
to an angle of 45"^. After the fourth sitting the leg could be raised almost 
to the horizontal ; electrical excitability considerably improved. After the 
sixteenth sitting, recovery almost complete ; walking only interfered with 
by the enlargement of the knee. 

87. Obser cation by Benedikt. Paralysis and atrophy of the quadriceps in 
consequence of gonitis. — A girl, aged fourteen years. Had inflammation d 
the knee-joint three years ago ; the secondar)* flexion contracture was re- 
lieved by forced extension. Complete atrophy and paralysis of the quad- 
riceps were then found ; electrical inexcitability. Local galvanization and 
faradization ; complete restoration of the muscles after treatment for a 
number of months. 

88. Obser cation by Le Fort (VaUaJt). Traumatic hydrarthrosis of the 
knee; atrophy of the quadriceps, — A man, aged thirty-five years. Had 
marked swelling of the knee and difficulty in walking as the result of a 
fall (March, 1874). Usual treatment : counter-irritation, tight bandage, 
etc. The effusion disappeared, but the difficulty in walking persisted. 
July, 1874, marked atrophy was found in the anterior thigh muscles, which 
appeared to be entirely powerless. Treatment ; daily £radization of the 
atrophic muscles for a few minutes ; application, every night, of a con- 
stant galvanic current, An in the groin, Ca on the call Marked improve- 
ment in two weeks, complete recovery in a month. 



The method of treatment of these simple atrophies is essentially the 
same as that of neurotic atrophy ; an attempt is made, by means of regu- 
lar galvanic and faradic stimulation of the muscles, to improve their nu- 
trition, restore their volume and increase their power. Care must be taken 
not to employ, at the outset, too strong currents or too prolonged a period 
of application. It is also advisable to stimulate the nutrition of the mus- 
cles by excitation of the nerve-trunks and perhaps also of the trophic cen- 
tral apparatus 

The results of treatment depend mainly upon the cause of the atrophy, 
but, as a rule, persistent and long-continued treatment will be necessary. 

The pathogenesis of pseudo-hypertrophy and true hypertrophy of the 
muscles is still very uncertain : the assumption that we have to deal, in 
these affections, with neurotic or spinal disorders remains unproven. 
Electrical treatment may be adopted according to your own judgment 
and theoretical considerations. In addition to peripheral treatment I 



SPECIAL ELBOTBO-THEBAPEUTIOS. 238 

should not ftdl to make galvanic applications to the spinal trophic centres 
(galvanization of the spine, of the sympathetic). But the results hitherto 
obtained by electro-therapeutics in these diseases are scarcely worthy of 
notice. 

This also holds true of another rare and remarkable form of disease, 
the tonic spasms of Toluntarily moved muscles, the so-called myotonia 
congenita (Struempell). The various attempts to reheve this peculiar dis- 
ease by electricity have proven useless. 



V. PAIN NEURALGIA AND NEUBALGIFOBM 

AFFECTIONS. 



LECTURE XXV. 

Introdaotion — Definition and Nature of Pain and Neoralcr^a — ^The Nenralgio Change^ 
Bleotro-therapeatio Objeots : liemoval of the Abnormal Nutritive Oonditiona in ibe 
Nerves and of the Gaases of the Neoralgio Change ; tiie Actioni of the Cozxeot 
Available for this Purpose ; Oases— Electro-therapeatio Methods : Causal Treat- 
ment — Anti-neuralgio Methods : Direct, Application of the Gahranio and the Faca- 
dio Current ; Indirect, Electro-cutaneous Brush ; Galvanic Treatment of Painful 
Points — General Plan of Treatment— Besults. 

Those morbid irritative processes in the sensory nerves which are 
manifested as hjpersesthesia and pain are veiy often the object of electrical 
treatment. 

It is especially those forms of painful irritation of the sensory nerves 
which have a certain independence, appear as peculiar, well-defined mor- 
bid processes, and are included under the general terms neuralgia and 
neuralgiform pains against which the efforts of electro therapeutists are 
preferably directed. But the electrical current has also proven useful in 
not a few cases of other painful affections, which have nothing in common 
with neuralgia and do not even merit the name of symptomatic neuralgia. 

The indications for the employment of electrical currents against pains 
and neuralgias were not so evident as in paralysis ; so long as electricity 
v^as known as a nerve-irritant alone its application in irritative conditions 
of the sensory nerves could not be regarded as very promising. How- 
ever, electrical currents were employed in pain and neuralgia long before 
the modifying, sedative action of the current had been recognized, and 
the undoubted and frequent successes soon formed a broad basis for fur- 
ther investigations in this field of therapeutic& At the present time we 
possess in the electrical current one of the most certain and brilliant 
remedies for neuralgia, although we must admit that much progress has 
not been made in our knowledge concerning its mode of action in these 
forms of disease. 

In this instance, also, it appears imavoidable to throw a glance at the 
question of the nature of pain and neuralgia, since in this manner alone 



SPECIAL ELBCTBO-THBBAFEUnOS. 235 

can we arrive at a rational electro-therapeutics. But the outlook is not 
Texy consoling. Despite the daily occurrence of these symptoms and 
forms of disease, despite centuries of observation and investigation, we are 
still deplorably ignorant with reference to the nature and pathogenesis of 
pain, and especially of neuralgia. 

Pain is produced by every sensory irritative process which exceeds a 
certain intensity ; it is the reaction of consciousness upon a certain 
strength of centripetal stimulation. This intensity of stimidation may be 
produced either by the greater intensity of the stimulus or by an increase 
in the irritability of the sensory apparatus, so that very slight stimuli will 
give rise to the pain-producing process of excitation. But here the un- 
certainty begins, because we do not always know — perhaps only in the 
rarest oases — in which of these two ways the pain of disease is produced 
Probably, however, we have to deal generally, in pathological cases, with 
an increased excitability caused by finer nutritive disturbances of the sen- 
sory apparatus, so that the ordinary slight physiological stimuli, such as 
the movement of the blood and of parts of the body, tension of the tissues, 
perhaps also chemical substances in the blood and fluids of the tissues, 
may give rise to a sufficient intensity of the irritative process. 

Still more difficult is it to form a conception of what is known as neu- 
ralgia and the recognition of its more intimate relations to the causal 
factors. The term neuralgia refers to pains of great intensity and pecu- 
liar quality which arise spontaneously, t.e., from pathological processes 
in the body itself, are confined to one or more definite nerve-trunks, are 
perceptible throughout the entire distribution of the latter and present 
distinct exacerbations and remissions, even complete intermissions. These 
pains appear to be produced, in many cases, by finer nutritive disturb- 
ances in the nerves, which elude our present histological methods (as in 
idiopathic neuralgias, those due to exposure, malaria, poisons of all kinds, 
ansamia, hysteria, neurasthenia, spinal irritation) ; while, in a large pro- 
portion of cases, they are the results, or, at least, the concomitants of 
grosser anatomical changes in various parts of the sensory apparatus (in- 
juries, foreign bodies, compression, inflammation and degeneration of the 
peripheral nerves, neuromata, diseases of the spinal cord, tabes, probably 
also diseases of the brain, syphilis, etc.). More careful consideration 
shows, however, that all these factors do not give rise to neuralgia in a 
direct manner, and that neuralgia is entirely different from the sensory 
irritation directly produced by its causes. We are thus forced to the 
conclusion that the action of these factors gives rise to the production of 
something else in the nerves which causes the neuralgia, and the hypothet- 
ical conclusion has thus been reached that neuralgia is a distinct, peculiar 
form of nutritive disturbance in the sensory nervous apparatus to which 
Moebius has applied the term ''neuralgic change." This peculiar change 
in the nerves gives rise to the characteristic symptomatology of neuralgia* 



236 ELECTBO-THBRAPEUnCS. 

So long as it lasts, the neuralgia also will last ; if its causes continue, the 
" neuralgic change" will continue, or, if it has been temporarily remored, 
will be produced anew ; this change may also acquire a certain independ- 
ence and continue after the cessation of its causes (habitual neuralgia). 
This change mny be established, as it seems, in Tarious parts of the 
sensory tract (in the peripheral as well as the central course) ; at all 
events, it is not proven that it is always found in one spot, for example, is 
the posterior spinal roots or in the ganglion cells of the posterior gray 
colunms ; we know still less concerning the real character of this " neu- 
ralgic change '* and it is, at all events, not probable that it is due under all 
circumstances to hypencmia or slight neuritis. 

It is not my office to enter in detail into the symptomatology of neu- 
ralgia. I will merely emphasize the fact that it is important to the elec- 
tro-therapeutist to be accurately informed with regard to the location of 
the neuralgia in this or that nerve-trunk, if possible concerning its height 
in the conducting fibres and its grosser causes, the primary disease, eta ; 
that he should not fail to be informed veith regard to the presence (xt 
absence of YaUeix, painful points, and that it is advisable, in many cases, 
to search for more remote painful points, especially in the neighborhood 
of the spinal column (apophyseal point of Trousseau). 

Electrical examination has acquired hitherto no noteworthy signifi- 
cance in neuralgias and has not added anything to the recognition of the 
finer molecular changes in the sensory nerves — ^perhaps because they have 
not been carefully sought after. The electrical examination has been 
confined to the demonstration of hypersesthesia or anaesthesia of that por- 
tion of the integument affected with neuralgia, of painful points in the 
nerve-trunk or its branches, or finally of galvanic painful points upon the 
vertebral column (M. Meyer, Brenner). 

From these introductory remarks it follows that the first electro-thera- 
peutic object in neuralgia is the removal of the abnormal condition of 
nutrition and excitation in the nerves, in other words, of the '* neuralgic 
change." But even if this is effected — and, as it seems, it may be done 
by the electrical current with some amount of certainty in many cases — it 
will not suffice to produce a permanent cure of the neuralgia in all cases ; 
if the causes of the latter continue, the disease will again develop. We 
have, therefore, a second and often much more important and difiScnlt 
object, viz. the removal of the causes of the neuralgic change. I will con- 
fine myself to a brief consideration of those effects of the current from 
which we may expect, with more or less reason, a favorable influence upon 
the neuralgia. 

As the clinical phenomena force us to assume very slight changes of 
nutrition and of the molecular conditions in nerves affected vrith neuralgia, 
and as we may assume that these changes are accompanied, in the majority 
of cases, by increased excitability, we must rely chiefly upon the modifying 



SPECIAL £L£OTBO*THBBAPEUnOS. 237 

effects of the electrical current, ue,, diminution of irritability, production 
of anelectrotonus, the so-called sedative (antineuralgic) action. 

The catalytic effects may also be utilized in the removal of the finet 
nutritive disturbances, and these also possess a decided action upon an 
entire series of causal factors of neuralgia, viz., hypersemia, neuritis, de- 
generations, all possible diseases of the brain and spinal cord. 

Finally, the stimulating effects may also be employed for the produc* 
tion of very vigorous sensory irritation, which possesses an extensive ap- 
plication as a so-called '' counter-irritation " in neuralgias and other pain- 
f ul affections. However obscure this notion may be, it has nevertheless 
been established by experience that conditions of abnormal sensory irri- 
Hation may be relieved, temporarily or permanently, by sensory irritation, 
either in the same, or in symmetrical, or in remote nerve paths, whether 
this is accomplished by molecular transformations, or by over-stimulation 
and exhaustion, or by means of central inhibition (perhaps, also, by reflex 
circulatory changes and the like). At* all events, the electrical current is 
one of the most certain and vigorous, np well as harmless, means of pro- 
ducing a strong counter-irritation. 

Whether these actions of the current are the sole ones which are avail- 
able in neuralgia or not, there is no doubt that the personal experience of 
every electro-therapeutist furmshes numerous examples of the admirable 
curative properties of electricity in neuralgia. I will now give a few illus- 
trations of the recoveries which may be secured by various methods : 



89. Observation by Weise, IntermitterU right supra-orbital neuralgia. — 
At the end of December, 1866, after a coryza, an attack of supra-orbital 
neuralgia developed, assumed an intermittent character, and recurred 
daily in very violent paroxysms which ended with perspiration. Quinine 
and arsenic useless. Gkdvanic treatment begun January 17, 1867 : An to 
the supra-orbital foramen, Ca to the neck stabile for three minutes, with 8 
elements. Considerable relief forthwith ; the neuralgia disappeared per- 
manently after the close of the sitting. Fresh attack of same neuralgia 
twelve years later, which did not yield to quinine, but disappeared after a 
single stabile application of the An. 

90. Personal observation. Intermittent right supra-orbital neuralgia. — 
A man, aged fifty years. Sick for two weeks ; characteristic localization 
of the pain in the supra-orbital; no coryza, no malaria. Violent pain 
from 8 A,VL to 5 p.m. ; freedom from pain at night ; painful point. 

February 17, 1882. — Galvanic treatment with An stabile ; no paroxysm 
in following three days. 

February 20th. — Return of pain. Second sitting followed by cessation 
of pain, which returned in very mild form. Complete recovery in two 
further sitting& 

91. Personal observation. Neuralgia of the right trigeminus (third branch). 
— A woman, aged forty years. Had a similar affection on the left side ten 
years ago, which lasted a year. For two months pain in the distribution 
of the right infra-maxillary and auriculo-temporal nerves, occurring with 



238 XLEOrBO-TH£BAPEUTIOS. 

special Tiolenoe toward eyeoing and during the nigfai Painful points at 
the mental foramen and in front of the ear. 

February 16, 1866. — G^vanic current, descending stabile through the 
auriculo-temporal nerve and along the lower jaw (two to three minutes in 
each position). No pain during the next night for the first time in mmmj 
weeks. Permanent recovery after five sittings. 

92. Personal observation. Neuralgia of ike right trigeminus {tic-doulou^ 
reux), — A woman, aged forty-seven years. Suffering for four years from 
an increasing violent facial neuralgia, chiefly in the infra-orbital nerve, af- 
fecting the malar bone, superior maxilla, nose and upper teeth, and, at the 
height of the paroxysm, radiating into the inferior maxilla and lower teeth. 
AcUve spasmodic twitching around the angle of the jaw during each attack 
Origin imknown ; no distinct painful points. At first galvanic treatment : 
An stabile, for three to four minutes, upon the upper and lower jaws and 
in front of the ear, the current being gradually increased and diminished ; 
no sign of improvement after five sittings. Then 8 elements stabile from 
the forehead to the neck, galvanization of the sympathetic, and An stabile 
in front of the ear ; no improvement after three sittings. Then faradiza- 
tion transversely through the head, Ca on the right side, with increasing 
currents. Improvement forthwith, which continued to make considerable 
progress during the next two weeks, so that the patient had complete rest 
at night, the reflex spasm disappeared, and very few mild paroxysms oc- 
curred during the day. The patient was compelled to discontinue treat- 
ment. 

93. Observation by Moritz Meyer, Trigeminal nettralgia — ^A woman, 
aged thirty-five years. Suffering for three months from violent neuralgia 
of the left trigeminus, mainly in the third branch, occurring in five to six 
paroxysms daily. Quinine, arsenic, veratrine ointment useless. Fkradio 
brush to the neck at first produced great increase of pain for half a day, 
then striking amelioration. Permanent recovery after two more sit- 
tings. 

94. Observation by Wiesner, Trigeminal neuralgia (tic-douloureuje), — ^A 
man, aged sixty-four years. Suffered for four years from left trigeminal 
neuralgia (in the malar bone and deep in the skull). Various operations 
caused merely temporary relief. Recently twenty to thirty paroxysms daily 
of great violence ; 0.50 morphine administered daily. Qalvanic treatment 
(the most painful parts placed between the electrodes twice a day, for five 
minutes) caused improvement in three days, which slowly progressed ; 
the tic disappeared after two months, and the patient was discharged as 
cured for the present 

95. Observation by Moritz Meyer, Bight occipital neuralgia. — An officer, 
aged thirty-two years. Suffering for two months from violent pains in 
right occiput and neck. Vigorous faradic brush to the neck ; immediate 
subsidence of the pains, and complete recovery after two sittings. 

96. Personal observation. Neuralgia of the median nerve. — A woman, 
aged twenty-eight years. Suffering for six weeks from violent neuralgic 
disturbances in the distribution of the right median nerve, from the el- 
bow to the fingers. Nocturnal exacerb«ition of pain. Gkdvanic treat- 
ment, descending stabile through the median for three to four minutes. 
Much less pain on the following night ; recovery after the second applica- 
tion. 

97. Personal observation. Neuralgia of the radial nerve. — A girl, aged 
eight years. Suffering for nine weeks from severe pain, and markedby 



8PS0IAL BLBOTBO-THBBAPEUnOS. 239 

peraBstheaia of the right thumb ; the pain radiates along the radial border 
ol the thumb and forearm aoroes the outer surface of the arm to the 
shoulder ; yery distinct painful points in several positions. The thumb 
extremely sensitive to the slighteist touch ; complete inability to use the 
hand ; no swelling or inflammation. Gkdvanio treatment : 8 to 12 ele- 
ments descending stabile from the radial nerve in the arm to the thumb 
aad wrist-joint ; eight elements An stabile upon the plexus. Distinct im- 
provement after two sittings, complete recovery after nine sittings. 

98. Observaiion by Seeligmuelier. Neuralgia of the lesser internal cutO' 
neou9 neroe of the arm, — A woman, aged forty-three years. Suffering fcnr 
eight years from neuralgic disturbances in the left arm ; examination dis- 
closes a neuralgia confined to the lesser internal cutaneous nerve. A pain- 
ful point along the spine. Galvanic treatment : Ca on the painful point. 
An stabile to the nerve in the arm for six to ten minutes, the current 
being gradually increased and diminished. After the first sitting the pa- 
tient was free from pain for twenty-four hours, for the first time in eight 
years. The patient was discharged cured after a few more sittings. 

99. Personal observation. Intercostal neuralgia ; herpes zoster. — ^A girl, 
aged fiftten yeara Suffering for four days from intercostal zoster, corre- 
sponding to the fourth to seventh intercostal nerves, with neuralgic pains 
in the same distribution. These pains continued for two weeks despite 
internal treatment Gkdvanic treatment. Pains disappeared in five days. 
After disoontinuanoe of treatment, pains returned in five days. Renewal 
of galvanic application produced recovery in ten days. 

100. Pergonal observation. Intercostal neuralgia ; mastodynia. — ^A girl, 
aged twenty-six years. Suffering from eight to nine months with shooting 
pains in the breasts, accompanied by secretion of milk ; pains sometimes 
very severe, remittent and radiating into the back and inner aspect of the 
arms ; tenderness of most of the dorsal vertebrsB ; anaemia. Galvanic 
treatment: An upon the dorsal spine, Ca on the sternum, 14 to 20 
elements stabila Distinct improvement after a few days, but no further 
progress. Then &radic treatment (stroDg currents with large moist elec- 
trodes) ; also followed by distinct improvement, the disease being reduced 
to two slight attacks daily. Complete recovery not effected. 

101. Personal observation. Sciatica. — A man, aged twenty- three years. 
Suffering for five days from neuralgic pains in both legs, from the hips to 
the feet. Exacerbation at night so that patient was unable to sleep; 
paraesthesise in the feet. Galvanic treatment descending through the 
sciatica, the electrodes being applied at a distance of six inches from one 
another along the entire course of the nerves ; a few interruptions. Pain 
diminished forthwith, and patient able to sleep tolerably welL No pain at 
night after the second sitting. Cured after fourth sitting. 

102. Personal observation. Sciatica. — A man, aged fifty-five years. Suf- 
fering for three months from left sciatica ; characteristic localization of 
the pain, with several painful points ; violent paroxysms, especially at 
night ; sleep disturbed ; left leg somewhat emaciated ; walldng interfered 
with. Hypodermic injections of morphine useless. Gkdvanio treatment : 
descending stabile through the nerve, with a few interruptions of the cur- 
rent at the close. Considerable improvement after the first sitting, and 
complete recovery after nine sittings. 

103. Observation by Moritz Meyer. Sciatica. — A merchant, aged forty- 
four years. Suffering for six months from right sciatica in consequence 
of a railway injury. Yery violent pains ; painful point at the sciatic fora* 



240 BLEOTRO/rHEBAFBUnO& 

men. Faradio brash in this region followed by immediate disappearance 
of the pain ; reappeared to a alight extent on the following day. Beooreiy 
after two further sittings. 

104. ObservcUion by Brenner. Sciatica. — The patient suffered for four 
months from extremely yiolent sciatica, and was compeUed to He in bed for 
a month at the beginning. Peripheral electrical treatment ameliorated the 
pain in the leg but not in the upper part of the sciatic and the ileo-bypo- 
gastric pain. Examination showed intolerable pain upon application of 
tiie Ca to the dorsal and lumbar vertebrae, which were not tender on press- 
ure. Application of the An to these parts produced considerable reli^ 
forthwith, and after eight sittings patient was almost entirely free from 
neuralgic pains ; galvanic painful point disappeared. 

105. Sdf-observaium by Brenner. Neuralgic pains in the foot as the re- 
sult of articular rheumatism. — During an acute rneumatic polyarthritis, in 
which both ankles were affected, Brenner suffered from violent paro^smal 
pains radiating into the feet, which resisted all remedies and rendered 
sleep impossible for three weeks. A single application of a moderately 
strong faradic current to the ankles with broad moist electrodes^ relieved 
the violent pain immediately and permanently. 

From these observations it follows with certainty that many caaes of 
neuralgia are cured by the electrical current in a surprisingly rapid man- 
ner and that this may be effected by various methods. But the superi- 
ority of one method over another cannot be inferred by any means, nor 
does this follow from the statements of those who have adopted a certain 
method more or less exclusively. In individual cases it would seem that» 
when one method fails, another may prove useful, but tlus does not occur 
often, by any means, and I have veiy frequently had the impression that 
those forms of the disease which will yield to electrical treatment, will be 
favorably affected by every form of current and every method of applica- 
tion which is not entirely irrational. 

In the determination of the electro-therapeutic method our first object, 
in many cases of neuralgia, is the removal of the causal disease. I have 
very little to add, in this respect, to the remarks made in previous lec- 
tures (Lectures XYI. to XXI.). We have to deal mainly with the electrical 
treatment of those diseases of the brain, spinal cord, and peripheral nerves 
which give rise to neuralgia or neuralgiform pains. Their treatment is 
carried out according to previously mentioned principles and methods, 
and must be resorted to at the onset in so-called symptomatic neuralgias 
(tabes, meningitis, neuritis, etc.) ; as a rule, we must apply the galvanic 
current, more rarely the faradic current for the sake of its reflex effects 
from the integument. 

But as not a few neuralgias are developed in general neuroses (hyste- 
ria, neurasthenia, spinal irritation, diabetes, etc.) or in general constitu- 
tional anomalies (ansemia, chlorosis, cachexia of all kinds, etc.), electrical 
treatment directed against these conditions may be useful occasionally. 
Under such circumstances general faradization may be recommended very 



SPECIAL SLEOTBO-THBBAPEUTICS. 241 

highly, and likewise general or central galvanization. I will return to 
this subject in subsequent lectures. 

But the main purpose to be effected, under all circumstances, in idio- 
pathic and symptomatic neuralgias, and which may be attempted even 
though the primary affection is incurable, is the removal of the morbid 
conditions in the sensory nerves themselves, of the ''neiuralgic change," 
i.e., the production of an anodyne, antineuralgic action of the electrical 
current. This may be secured either in a direct or an indirect manner. 

As a rule, the direct method is adopted firsts either the galvanic or the 
faradic current being employed. Its object always is the diminution of 
excitabiUty and the modification of the nutritive conditions of the sensory 
nerves — t.e., the production, in a certain sense, of a catalytic action. 
Above all, the stabile action of the galvanic current should be employed, 
and the stabile appHcation of the An should be made to the diseased 
part on account of its notoriously sedative, anelectrotonic action. The 
An shoidd be placed upon the site of disease, at all events upon the 
painful nerve-trunk, over as large a sur&ce as possible, perhaps, also, 
upon the individual painful points. The application should be mod- 
erately strong, but gradually increasing in intensity, and somewhat pro- 
longed. Very vigorous stimulation, especially interruptions of the cur- 
rent, should be carefully avoided, and in many cases it seems indispensable 
to diminish gradually the strength of the current at the dose of the anodal 
appHcation, in order to avoid the " opening " irritation and the subsequent 
positive modification of irritability ; this is very readily effected by grad- 
ually diminishing the number of elements, or by means of a suitable 
rheostat The position of the Ca may be entirely indifferent, and should, 
at all events, be made in such a manner that the An, according to the laws 
of the diffusion of the current, possesses the most intense effect possible ; 
the Ca may afterward be appUed upon certain painful points. This method 
does not always produce the desired object^ and a trial of the stabile ap- 
pUcation of the Ca is then by no means excluded ; it is possible that the 
catalytic action of this pole may have a more &vorable effect upon the 
''neuralgic change," and thus prove curative. At all events, a large expe- 
rience teaches that the appHcation of the Ca to the painful points (even if 
the An is not appHed directly to the nerve-trunk) may have a favorable 
antineuralgic addon. I have frequently seen the lancinating pains of loco- 
motor ataxia, especially when associated with circumscribed hypersesthesia 
of the skin, disappear as if by magic from the appHcation of the Ca to 
these portions of the skin (An upon the spinal column). 

As we have to deal mainly with large tracts of nerves, for example, with 
the nerves of the extremities, both poles may be appHed to the nerve, and 
the current allowed to flow either in an ascending or descending direction. 
As a rule, the descending current is preferred for this purpose, and a 

greater sedative action is attributed to it — whether justly, has been 
16 



242 SLBOTSO-THSBAPEUnCa. 

aoaroely decided, but it probably depends upon the fact tiiat the An is ap- 
plied to the central portion of the nenre. The chief requirement is iia 
stabile application, in addition to the avoidance of unnecessary irritant 
ettects. The An is placed as centrally as possible upon the nerve-trunk or 
the vertebral colunm, the Ca upon a more peripheral part, especially upon 
the individual painful pointa When the nerve is very long, several of 
these applications may be made in succession from the centre to the pe- 
riphery, the electrodes being situated at a distance of about twenty to 
twenty-five centimetres from one another (eiq>ecially in sciatica). When 
the neuralgia occurs in mixed nerves and is associated with stiflhees, weak- 
ness, and pain in motion, it may be useful to produce a few muscular con- 
tractions by closure of the current at the close of the sitting ; the con- 
comitant symptoms are usually relieved by this procedure. 

Finally, another effective procedure is the constant application of weak 
galvanic currents {vide page 120), which has been recommended on all 
sides. I possess no very large personal experience with this method, but 
believe that it is to be specially reconmiended for very irritable individuals 
with fleeting or often-recurring neuralgias, particularly in spinal irritation 
and hysteria. It should not be foi^tten, with regard to the choice of the 
site of application, that the zinc plate of simple galvanic elements is the 
anode. 

The same object is subserved by the passage of a moderately strong 
faradic current through the diseased nerve (by means of moist electrodes); 
how this acts it is difficult to say, but the fact of its efficiency is undoubted. 
It is best to begin with moderately strong currents, which are passed 
through the nerve for three to ten minutes ; this produces great relief at 
the onset, and perhaps recovery after repeated applications. If recovery 
does not ensue, a stronger current should be employed, perhaps in the 
form of the so-called " swelling " current, gradually increasing and dimin- 
ishing. 

In an indirect manner, good results in neuralgia may also be obtained 
in various waya In the first place, by the production of a violent counter- 
irritation with the aid of the faradic brush. This method, which has been 
often employed with brilliant results, but is not very agreeable to the pa- 
tient because very painful, consists in vigorously stimulating the skin by 
means of the electrical (fiuradic or galvanic) brush. According to Du- 
chenne, the irritation of the skin is effected in the neighborhood of the 
painful spot, or, if this is not sufficiently sensitive, in some other part. 
Moritz Meyer states that good results are only obtained from this proce- 
dure when anaesthesia of the skin is present in addition to the neuralgia. 
According to him, a better effect is obtained from the application of the 
so-called electrical moxa (fixation of the electrical brush upon a certain 
part of the skin, or the passage of sparks from the brush, which is removed 
one millimetre from the skin) to the principal painful point on the nerve, 



8PE0IAL ELEOTBO-THBBAPBUnOS, 248 

Or to its point of exit from the central organ. This application should 
last from a few seconds to a minute. If it does not produce the desired 
efGdct in a short time (after two to five sittings), similar counter-irritation 
may be applied to the corresponding parts on the healthy side, or to the 
distribution of adjacent cutaneous nerves, or even to remote parts of the 
kddn (helix of the ear, wing of the nose, nipples, neck, etc.). 

A case reported by Wiesner proves that the galvanic (Oa) brush is also 
available in the same manner. One of my colleagues kept within bounds 
k very severe supra-orbital neuralgia of many years' standing by the appli- 
cation of the galvanic brush to the forehead, but he moderated the dis- 
agreeable features of the application by the interposition of moist tissue- 
paper. Seeger has employed a similar procedure in sciatica ; he strokes 
large portions of skin over the diseased nerve with the cathode brush, 
until redness and wheals are produced (and then employs these parts;, 
which are thus converted into better conductors, for the application of 
moist tissue-paper and the introduction of the current through it by 
means of ordinary electrodes). 

The galvanic treatment of the painful points upon the spinal column, 
etc., may also be regarded as an indirect treatment of neuralgia. Moritz 
Meyer, Seeger, and Brenner have directed their attention to this method, 
and found it useful in many severe neuralgias (brachial and intercostal 
neuralgias, sciatica, etc.). The method consists of the stabile application 
of the An of a moderately strong current 

General principles, and, to a still greater extent, the peculiarities of 
the individual case are decisive with regard to the intensity and dura- 
tion of all these methods of treatment. Under all circumstances it is 
advisable to begin with weak currents and short sittings, to avoid unneces- 
sary irritative action, sudden closure and opening of the current and the 
like, and not to omit the gradual diminution of the current More than 
three to five minutes of a galvanic, and five to ten minutes of a faradic 
application are scarcely necessary ; a number of sittings in one day some- 
times prove useful. 

With regard to the general plan of treatment, it is advisable to begin 
with milder procedures, especially when we are not acquainted with the 
patients or they are very sensitive. In the beginning, ilierefore, in addi- 
tion to the causal treatment, make a stabile application of the An or weak 
descending galvanic currents, perhaps also feeble faradic currents, which, 
in very sensitive individuals, may be applied by means of the ''electrical 
hand." Stronger currents, the faradic brush or the moxa, should not be 
employed xintil the former methods prove unsuccessful 

The results of these various forms of treatment are often very brilliant, 
and it may be said, on the whole, that neuralgia is one of the most grati- 
fying objects of electro-therapeutics. At least a temporary benefit is ob- 
tained in almost all cases ; the patient experiences relief during the passage 



244 ELEOTRO-THEBAPBUnCa 

of the current, and the pain has either entirely disappeared or is consider- 
ably relieved after the close of the application. But this is not always the 
case, as there are forms in which not even temporary benefit is obtained, 
the pains continue with undiminished severity, and are even increased hj 
the electrical current ; it is rare that such an increase of the pain is fol- 
lowed by permanent improvement (vide Observation 93). In such oases 
the treatment should not be long continued. 

In favorable cases the temporary improvement may continue, and the 
disease is cured after one or two applications. Or the pain returns, per- 
haps with diminished severity, after a longer or shorter interval Each 
new sitting produces renewed relict imtil finally recovery occurs after a 
longer or shorter period. You should not be repelled in such cases by 
the trouble of long-continued treatment In unfavorable cases the tempo- 
rary improvement does not make any progress, and the neuralgia remains 
incurable ; the causes apparently lie in the character and incurability of 
the primary disease, but we are not always able to recognize this fact^ and 
apparently very favorable idiopathic neuralgias may present an unexpected 
resistance to electrical treatment 

It is not easy to foretell whether a neuralgia is curable by electricity 
or not. The diagnosis is too uncertain in many cases for such a purpose. 
But experiences teaches that the outlook is relatively favorable in pure 
idiopathic neuralgia, in the rheumatic and neuritic forms, in those due to 
anaemia, neurasthenia, and hysteria, perhaps also in many malarial neu- 
ndgiaa It is unfavorable, on the other hand, and palliative efifects may, 
at the most, be looked for in the majority of symptomatic neuralgias, as in 
affections of the brain and spinal cord, in severe peripheral nerve lesions, 
in chronic hysteria and neurasthenia, and especially in the severe facial 
neuralgias which are known as true tic-douloureux. 



LECTUBE XXVI. 

Indiyidnal Forms of Neuralgia : 1. Trigeminal Neuralgia ; Practical Remarks Gonoem- 
ing the Individual Methods of Treatment — 2. Cervico-oocipital Neuralgia — 8. 
Headache and Migraine ; Various Methods of their Treatment— 4. Gervico-hra- 
ohial Neuralgia — 5. Intercostal Neuralgia — 6. Neuralgia of the Lumhar Plexus — 
7. Sdatioa ; Various Methods of Galvanic and Faradic Treatment ; Neuralgia of 
the Urinazy and Sexual Organs ; Goccygodynia — 8. Neuralgia of the Joints — 9. 
Visceral Neuralgias : Neuralgia of the Pharynx and Larynx; Angina Pectoris ; 
Gastralgia ; Enteralgia ; Lead Golic ; Neuralgia in the Distribution of the Pelvic 
Nerves. 

Afteb the previous detailed remarks concerning the electro-therapeu- 
tics of neuralgia in general, I may restrict myself to a brief consideration 
of the individual forms. 

1. Neuralgia of the trigeminus and its branches presents great difficul- 
ties to electrical treatment on account of the deep situation of the nerve 
and its branches, and also frequently on account of the severity and incu- 
rability of the disease (morbid processes at the base of the skull, aneurism 
of the carotid). Slight consideration will show that the trunk of the nerve, 
the ganglion of Ghisser, and the three main branches lying deep in the mid- 
dle fossa of the skull, cannot be readily influenced by the current, and this 
is also true concerning a portion of the course of the branches within and 
upon the floor of the orbital cavity and in the spheno-palatine fossa. It 
will not be easy to produce a vigorous polar action in these localities, and 
still more must we renoimce the production of a definite effective direc- 
tion of the current in the nerve. The most serviceable method for the 
production of polar action will be the transverse or oblique conduction of 
the current from the middle of the temporal region, immediately above 
the malar bone, to the other side, or from behind the ear to the opposite 
side of the back of the neck. For the production of a definite direction 
of the current in the main branches the passage of the current from the 
neck to individual points of exit of the nerve wlQ scarcely be sufficient* 
We must help ourselves, in this respect, as best we may, and I think it 
best always to keep in mind the following object, viz., to bring the pre- 
sumably diseased portion of the nerve within liie field of the densest por- 
tions of the current, i.e., between both electrodes or in the immediate 
vicinity of one of them. Some of the peripheral branches of the nerve, 
especially the supra-orbital, auriculo-temporal, also the inframaxillary, are 



246 BLECTBO-THEBAPEUnOS. 

mueh more favorably situated in this reiq>ect. They may be readily sub- 
jected to polar action or to the passage of a descending current. This 
is effected less readily in the infra-orbital nerve, the terminal ramifica- 
tions of which alone can be vigorously influenced ; and this very nerve 
is by preference the site of severe " epileptiform " neuralgia, the true tio- 
douloureux. 

The treatment of these neuralgias is begun by the stabile application 
of the An to the individual branches and points of exit, or in the neigh- 
borhood of the main trunk. The Ca may be placed upon the sternum or 
in the opposite hand, or on the posterior or lateral part of the neck ; the 
current should be gradually increased and diminished, at first of moderate, 
later of greater strengtL If the disease is supposed to be situated at the 
base of the skull, you must employ quite strong currents. O. Berger has 
obtained very good results from this method, and it proves sufficient for 
the majority of milder cases. If it is ineffective, you may resort to the 
stabile application of the Ca to the points of exit of the nerve, or send a 
descending current through the individual peripheral branches, the An 
being fixed in the neck ; or the same application with feeble, gradually 
increasing, faradic currents ; Bruzelius recommends that the latter appli- 
cations should be long continued (ten to thirty minutes). Finally, trial 
may be made of the faradic brush or moxa (perhaps also of the galvanic 
brush). These can hardly be employed in the &oe, though I have repeat- 
edly tried it ; a better method is the application of the brush to the nebk. 
11 Meyer employs two brushes, one being placed on the neck, the other 
in its immediate neighborhood, about one millimetre from the integument, 
in order to allow the passage of sparks ; the &radic brush may also be ap- 
plied to the helix of the ear. 

Not infrequently cases will be met with in which all these methods of 
treatment fail of success, especially in tio-doidoureux. Permanent relief is 
'veiy rare in these cases, and I openly confess that I cannot boast of a 
single cure in these severe chronic neuralgias, however many I have treated 
methodically and persistently. The most that I have obtained vtbb the 
temporary cessation of the attacks or a variable degree of amelioration ; 
now and then, however, recovery may result I will add that two or more 
sittings daily have appeared to me to be useful in some cases. 

2. The electrical treatment of cervico-occipital neuralgia does not 
present the slightest difficulty, since we have to deal with superficial, 
quite long nerve-trunks, which can be readily influenced as &r as their 
entrance into the central organ, and whose most frequent sites of disease 
are usually reached with ^ility. The methods are therefore readily de- 
termined ; in the flrst place, the stabile application of the An to the 
points of exit, i.e., the upper cervical vertebrse, the Ca upon the sternum ; 
or the descending stabile current, the Ca being placed upon the thor* 
oughly moistened scalp ; the faradic current may be employed with moist 



SPECIAL XLEOTRO-THEBAPBUTIOS. 247 

eleotaxxleB in the same maimer ; finally, the faradio brash or moza high u^ 
in the neek. The reeolts are usoally admirable, but some oases oooux 
which resist treatment The rare phrenic neuralgia is treated according 
to the same principle& 

3. I must dcTote some consideration to ^he electrical treatment of 
headache and migraine, since it often proves very serviceable to patienii 
suffering from these afifoctiona 

As a matter of course I refer alone to the so-called ** nervous ** head- 
ache, as it occurs under the most varied conditions, with or without grosa 
lesions upon or within the skull, \nost frequently in neuracttieiiia, 
hysteria, anaemia^ or as the result of rheumatism, toxic agents, etc 
Other forms of headache (in fever, syphilis, inflammations of the skull, 
coryza, meningitis, etc.) are scarcely ever the object of electro-therapeutic 
trials. 

It goes without saying that, in all such cases, the determination of the 
cause of the nervous headache is decisive with regard to treatment, and 
often some other remedy will better meet the causal indication than elec- 
tricity. Only in neurasthenia, hysteria, etc., can the causal indication be 
sometimes met by general faradization or some other electrical procedure. 
Direct treatment of the headache may be tried in addition ; this should be 
done in all cases in which no causal indication can be found or fulfilled. 
This may be accomplished in various ways. When the pain is diffused, it 
is best to begin with the passage of weak galvanic currents longitudinally 
through the skull ; if distinct vaso-motor disturbances are also present, 
you may place either the An or Ca upon the forehead, according to cir- 
cumstances ; in such a case galvanization of the sympathetic or tiie cervi- 
cal cord may also be employed. Gk>od results are often obtained from 
the stabile application of the An (large head electrode) to the scalp, the 
Ca being placed on the sternum, thigh, or hand, with a moderately strong 
current. I have occasionally obtained very favorable results from the 
passage of a weak faradic current from the forehead to the neck (two to 
five minutes), preferably by means of the " electrical hand ; " the faradic 
brush to the integument of the neck, chest, back, and upper limbs may be 
useful in some cases, especially when associated with vasomotor disturb- 
ances. If the headache is of a more localized character and isolated pain- 
ful points are present, the stabile anodal treatment of these points, or their 
faradization with moist electrodes, will prove serviceable. The results of 
all these methods of treatment cannot be foretold ; like other measures in 
these affections, electricity sometimes presents very brilliant, sometimes 
purely negative results^ 

That form of nervous headache which occurs in periodically i*ecurring 
attacks of usually unilateral very severe pain, associated with nausea, 
vomiting, general prostration, various vaso-motor disturbances, eta, and is 
known as hemicrania or migraine, has naturally continued to call forth 



248 BLBOTBO-THEBAPEUTICS. 

electro-therapeutic measures. I must confess that such attempts are gen- 
erally fruitless ; the brilliant results said to have been obtained by some 
authors (for example, Frommhold) by ihe electrical treatment of migraine 
have not been confirmed by others, and in this very respect migraine is 
distinguished from other neuralgias among which electro-tiierapeutics in- 
cludes its greatest triumphs. 

In the large majority of cases migraine is the expression of a congeni- 
tal or acquired nervous disposition, and is due only in rare cases to tem- 
porary, occasional injuries. Whatever produces migraine in predisposed 
individuals upon slight cause, or increases the violence and number of the 
attacks, may also give rise to the disease for some time in those very 
slightly predisposed to it ; but it is then usually manifested by isolated 
and not very severe attacks. The latter form presents the most favorable 
chances by far for electrical treatment, and on several occasions I have 
secured very rapid recovery in such cases. On the other hand, true 
migraine, as it occurs in so many neuropathic women and neurasthenic 
men, especially in " brain workers," and usually continues until advancing 
years, is a disease which is influenced witii difficulty, and is very rarely re- 
lieved even by the most careful electrical treatment ; we can scarcely ever 
hope for real recovery, and even any considerable amelioration is rarely 
effected. 

The true nature of migraine is still entirely unknown to us, and therein 
lies a part of the difiiculiy of treatment We known either in what part 
of the skull or its contents the pain is located, nor ai*e we acquainted with 
its more intimate patiiogenesis. The attempt to refer the pain to vaso- 
motor disturbances, to spasm or paralysis of the vessels, and, on the 
whole, to regard migraine as a disease of the sympathetic, I consider un- 
fortuiiate. sSce in STmajority of cases which I had the opportuniiy of 
observing, the much-discussed angiospastic and angioparalytic symptoms 
were absent during the attacks, and I must regard them, whenever present, 
as sequelsB or part-symptoms of the entire attack, the true nature of 
which is still entirely obscure. 

The electrical treatment of migraine must therefore be restricted 
mainly to empirical measures, and clear indications concerning the choice 
of the method will only be presented when marked vaso-motor disturb- 
ances, symptoms of irritation or paralysis of the cervical sympathetic, are 
present. 

As a matter of course the attempt should be made at the onset to re- 
lieve the primary disease, the constitutional neuropathy (neurasthenia, 
hysteria, anaemia, etc.), by electro-therapeutics (general faradization, cen- 
tral galvanization, electrical bath, etc.). You should then determine 
whether marked vasomotor disorders are present during the attack ; if so, 
the method of treatment of the sympathetic developed by Hoist, according 
to polar principles, should be instituted according to the character of these 



SPECIAL ELECTRO-THERAPEUTICS. 249 

eymptoms (paralytic or spasmodic). In the angiospastic form of migraine 
(pale, cool face, rigid, narrow arteiies, dilated pupil and palpebral fissure, 
increase of the pain upon compression of the carotid) a stabile application 
of the An (two to five minutes) is made to the cervical sympathetic (Ca in 
the hand or neck), the current being gradually increased and diminished ; 
in the angioparalytic form (red, hot &ce, pulsation of the dilated arteries* 
congestion of the retina, narrow pupil and palpebral fissure, diminution 
of pain during compression of the carotid) the Ca of a moderately strong 
current is applied to the cervical sympathetic (one to two minutes), and 
repeated openings and closures made, perhaps also a few interruptions ; 
too strong irritation should be avoided, since more marked dilatation of 
the vessels would develop in consequence. 

If no distinct vaso-motor disturbances can be demonstrated, you may, 
nevertheless, try one and then the other of Hoist's methods ; in addition, 
I have found some benefit from simple transverse and longitudinal con- 
duction of Hie galvanic current through the head, associated with the 
ordinary form of galvanization of the sympathetic. Moritz Meyer cured a 
case by the treatment of painful points upon the cervical spine. 

Finally, the faradic current may also be tried, either in the form of 
feeble, long-continued fiiradization of the head, preferably with the elec- 
trical hand, or also as the '^increasing faradic current," which has been 
praised to such an inordinate extent by Frommhold. By means of large 
flat sponge electrodes the primary faradic current is passed from the neck 
(anode) to the forehead, or to that portion of the temple which is always 
affected by pain in migraine ; a very mild current is first employed, and 
iben increased slowly and progressively, imtil an intense sensation is pro- 
duced in the head ; from iiiree to five minutes daily. 

All these methods of treatment must be continued for a very long time, 
usually months, even for years (with intermissions), if a permanent effect 
is looked for. We can only speak of improvement or recovery if no attacks 
occur, or their severity and frequency at least have very much diminished, 
despite the Qrdinary exciting causes in females, especially during men- 
struation. 

The electrical treatment of the attack itself is usually entirely useless, 
but Hoist reports a few favorable results by his method, in paroxysms 
which were associated with marked vaso-motor phenomena. Frommhold 
also states that he has often obtained temporary relief lasting sometimes 
for hours, by means of his method. I have hardly ever been so fortunate ; 
but veiy recently I obtained, by means of the galvanic current, a magical 
effect upon an attack of very severe (anomalous) migraine. But such 
cases are exceptional, and electricity is not a certain palliative for parox- 
ysms of this disease. 

4. Cervico-brachial neuralgias in their various forms are often brought 
to the notice of the electro-therapeutist, and present no dificulty in the 



250 ELEOTBOTHSRAPEUTIOS. 

choice of suitable methochi of treatment. The resnlts in the majoritj of 
rheumatic, neuritic, and similar brachial neuralgias, are usually ^erj satis- 
&ctory, though tiiey sometimes present an unexpected obstinacy. As in 
other cases, the prognosis of seyere symptomatic neuralgias is yeiy un- 
favorable. 

The choice of the method of treatorant depends entirely upon general 
principles. If possible, causal treatment in the beginning ; then, accord- 
ing to personal preference, the faradic currrent along the chiefly affected 
nerve-trunks, or the faradic brush to the affected nerve distribution, or to 
the spinal column in the region of the points of exit of the nerve& With 
the galvanic current painful points should be sought for upon the spinal 
colimin, the plexus, or the affected nerves, and a stabile application of the 
An made to such points (Ca to the sternum or back) ; the treatment of 
the brachial plexus in the supraclavicular fossa with the An is especially 
important in many of these cases. In addition, descending stabile cur- 
rents may be used, the An upon the plexus, the Oa upon the peripheral 
nerve branches, especially upon any points douloureux which may be 
present. If improvement is secured by sudi treatment, the stifhees and 
weakness, which may, perhaps, be left over in the muscles of the arm, 
may be removed by a few cathodal dosaras or by a labile api^cation. 
When complicated with paralysis, the neuralgia Aoold be treated firrt, 
then the putdysis. 

5. IntercofUd neuralgias often pr ese n t a imrah less Imnmble prognosis, 
and are occasionally very obstinate. The ibeomatic, neoritio, and trau- 
matic forms are relatively favorable ; but tliose forms windi are due to ver- 
tebral disease (caries, carcinoma), meningeal tumots, palmoiMxy phthisis, 
tabes, and the like, are very obsttinste and olten incnaMe, while those 
varieties which are associated with herpes Eoster in old pec^e crffeen pre- 
sent a surprising persistence. 

In addition to the causal treatment, in t ercostal neuralgia may be 
treated in the ordinary manner with the laradio current. A more 
favorable effect is often obtained from the galvanic current, either from 
the application of the An to the various painful points^ or successively 
along tiie entire length of the nerve (Ca indifferent ; vigorous current), or 
f^m the application of the An upon or immediately adjacent to the spinal 
column, the Ca being placed laterally and anteriorly upon the individual 
painful points. Mastodynia, which is merely a variety of intercostal neu- 
ralgia, is treated in exactly the same manner. 

6. Neuralgia of the lumbar plexus with its different varieties (neural- 
gia of the crural, lumbo-abdominal, obturator, and lateral cutaneous 
nerves) is treated according to the same principles as sciatica, which will be 
next considered. If it is not due to severe disease of the vertebrse or 
psoas muscle, of the pelvic organs, etc., it promptly yields, as a rule, to 
electrical treatment. As a matter of course, a necessary condition is the 



SPECIAL BLBOTBO-THEBAFBUnca 251 

most exact possihie determination of the affected nerve tracts. We maj 
employ a descending stabile current from the yetebral oolmnn (An) to the 
affected nerve trtmks, or the stabile application of the An upon the verte- 
bras and then upon the nerve trunks and the chief painful points (Ga 
upon the posterior surface of the thigh or the knee), or the application of 
the &radic current in the well-known manner. If the saphenous nerve is 
implicated, it sometimes requires special treatment in the leg. A few 
cathodal closures or labile irritation at the dose of the sitting appear to 
be not imimportani 

7. ScioHcci, one of the most frequent neuralgias, is accessible to elec* 
trical treatment in very many cases. The disease is of common occur-* 
rence among the laboring classes, but it is not unknown in the higher 
classes. The individual cases differ greatly with regard to etiology, locali* 
ration in the various nerves, severity and curability, and the results are 
therefore extremely variable ; they are imiformly favorable in the rheu* 
matic and neuritic forms, especially in recent and mild cases, also in those 
neuralgias due to inflammations of the joints and to injury; they. are 
much more uncertain and often entirely negative in the symptomatio 
forms due to diseases of the pelvis, vertebrae, and spinal cord. 

The methods of treatment are those ordinarily emj^loyed, modified by 
the deep position and great extent of the nerve, periiape also by tlie mkb 
of the lesion. In the frequent rheumatic forms the galvanic cureail 
should be first resorted to ; the descending stabile current (on aooooat of 
the great length of the nerve), the An being placed up<m the sacrum or 
in the region of the plexus or the sciatic foramen (if this is the chief site 
of the disease), while the Ca is placed lower on the nerve, upon the pain- 
ful points or the main branches. According to Bemak it is advisaUe to 
include small parts of the nerve (twenfy to twenfy-five centimeters long) 
in the current, and thus gradually pass along the nerve from the sacrum 
to the loot (for example, from the sacrum to the sciatic foramen, then 
from the latter to the popliteal space, finally from this to the ankle or the 
carpus), and allow a stabile application for one to three minutes in each 
spot ; after some relief is obtained, a few closures of the current or a 
short labile application is made, by which means the not infrequent stiff- 
ness and feeling of heaviness in the muscles are most certainly relieved. 
The deep position of the nerves and the great resistance of the integu- 
ment to conduction in the parts in question (with the exception of the re- 
gion of the knee-joint) necessitate strong currents and large fiat electrodes, 
especially if the patient is obese. The entire duration of a sitting should 
be four to ten minutes. It is not infrequently necessary to apply direct 
treatment to the individual branches of the nerve. 

I have obtained no less good results with the purely polar method, the 
anode being applied stabile to the various parts of the nerve (lumbar ver- 
tebrsa, plexus, sciatic foramen, points douloureux) and the cathode to the 



252 BLE0TBO-THEEAPKUTI08. 

Ulterior surface of the sbdomeo or thigh ; etrong currente are n 
and s few interruptioiiB are often useful in iucreasiii^ the effect The 
" circular current " of Remalc (fixation of the An upon the site of the le- 
sdon or pain, while the Ca is applied suocesmvely to a large number of 
poiuta lying in a circle around the An) is probably identical with the polar 
ftnodal treatment. 

In particularly obetinato cases you may try Benedikt's plan of intro- 
ducing one electrode into the rectum, the ottier being applied to the re- 
gion of the sacrum and loins, thus placing the sciatic plexus as directly as 
possible within the current, and influencing the lesion more intensely. 
Ciniselli recommends the prolonged application of simple galvanic ele- 
ments ; they may be fastened to the limb and back, and wont for days and 
weeks. 

Treatment with the foradic current may also meet with success, and 
should be employed in the ordinary manner, eitiier by the passage of a 
very strong faradio current through the trunk of the nerre and its 
branches, or by the application of the farodic brush to the int«gument irf 
the sciatic distribution, and the bradic moxa over the sciatic foramen, 
sacrum, lumbar vertebree, etc. Seeger has also employed the galranic 
brush with success. 

Other symptoms, such as amesthesia, paralysis, or muscular twitdunga 
and spasms, require special treatment according to well-known rules. 

jUI otiier forms of sciatica are treated according to the same methods, 
except that in many cases an especial causal application is superadded 
(in tabes and other diseases of the qiinal cord and the like). 

Neuralgias of the urinary and genital organs (pudendo4uemorrhoidal, 
apeimatio, urethral, ano-vesical neuralgia, etc.), which also belong to the 
sacral plexus, are of rare occurrence, and sufficient electro-therapeutio 
observations with regard to them have not been obtained. As a matter of 
course, galvanic and faradlc currents may be applied — and often with 
evident advantage — in these forms, and it will not be difficult for you to 
determine the method suitable to each individual casa This is also true 
of so-called coccygodynia, in so far as It requires the application of electric- 
ity on account of its true neuralgic character. Favorable results have 
also been obtained in this affection (Seeligmueller). 

o XT — ^gias of the joinU (articular neuroses) also require a brief 
)n. In part they undoubtedly belong to the true neuralgias, 
the large majority of cases upon an hysterical bosiB, and their 
herefore forms part of the therapeutics of hysteria {vide Lec- 
). They are most frequent in the knee and hip joints, more 
joints of the hands, feet, and shoulders. They may be asso 
all the classical symptoms of hyateria, but often present very 
olty in dii^^oatic differentiation from inflammatory, carious, 
S processes in the joints. In all such coses, however, a trial 



SPECIAL ELBCTBO-THBBAPEUnOS. 253 

ynih. electrical treatment will do no harm, and the rapid success of such 
an application maj contribute greatly toward clearing up the diagnosis. 

The various antineuralgic methods of application of electricity may also 
be serviceable in articular neuroses ; in addition to the electrical treatment 
directed against the primary affection, the transverse passage of feeble, 
afterward of strong galvanic currents through the diseased joint ; or ihe 
isolated stabile application of the An,' with the aid of large sponge elec- 
trodes, or moist compresses, which surround the entire joint, and serve as 
the An (Ca indifferent), or with small electrodes upon the principal painful 
points on the joint and upon any painful points which may be present in 
the spinal column ; anodal applications to the nerve trunks supplying Hie 
joint may also prove advantageous. If our object is not effected in this 
manner, we may pass vigorous faradic currents transversely through the 
joint, or apply the faradic brush energetically to the integument of the 
joint, the painful points, or the corresponding pfurt of the vertebral col- 
umn. The experience of O. Berger and Moritz Meyer, which I can con- 
firm in part^ teaches us that success is obtained occasionally by all these 
methods. 

106. Observation by Berger. Articular neuralgia. — A woman, aged 
thirty-eight years. Increasing pains in the knee-joint after a contusion 
of this part Best in bed, blisters, cotton-batting, etc., increased the suf- 
fering, which was associated afterward with muscular contractions and 
formication. Status at the end of four weeks : halting gait, pain in the 
knee, no external abnormaliiy of the joint; painful contractions of the 
flexor muscles ; tibial nerve tender on pressure ; extreme cutaneous hyper- 
algesia of the knee-joint and the lower third of the thigh. Treatment : 
faradization, An in the popliteal space, faradic brush to tiie skin over the 
knee and neighborhood ; strong current for four minutes ; faradic moxa 
upon a painful point near the patella. Inmiediately afterward the patient 
walked almost half an hour without pain. Another sitting held on the fol- 
lowing d^, although the symptoms had disappeared ; cure permanent 

107. Observaiion by Berger. Ariiadar neuralgia. — An anaemic and ner- 
vous lady, aged forty-five years, suffered a contusicm of the right knee in 
December, 1872. After a number of weeks, violent pains in the joint, 
radiating upward and downward, resisting all treatment, and finally impli- 
cating the left knee. Two months in bed without improvement 

J^y, 1873. — Cutaneous anaesthesia and analgesia in the right knee- 
joint with frequent formication ; a painful point on each side of the capi- 
tulum fibulae, also in the right popliteal space. The patient can walk only 
a few steps when led, the pains being extremely violent Treatment : sta- 
bile galvanization of both knee-joints with a moderately strong current for 
eight minutes. Considerable improvement immediately after the sitting ; 
the patient was permanentiy cured of her disease, which had lasted many 
months, after seven sittings. 

9. The so-called visceral neuralgias are still so obscure vrith regard to 
their character and development, that it is difficult to meet them with ra- 
tionally founded therapeutic measures Their occurrence is so frequently 



8fi4 BLEOTBO/rHBBAPieunCS. 

due to the presenoe of Berere anatomioal changes of the ocMxespoiidmg 
organs (cardiac diseaae, aneurisma, atheroma^ gastric ulcer, oarcinoma» 
etc.), or it is often so difficult to di£brentiate tiiem with certainty from 
such processes, that some uncertainty in therapeutics is readily explicable^ 
and we generallj restrict ourselyes to paUiative measures. Hitherto elec- 
tricity has been applieM)tit timidly to these aflfoctions, in parti because 
we do not know, as a rule, whether the neuralgia is located in the sympa* 
thetio, cerebral, or spinal nerves, whether it is of peripheral or centnd 
origin, etc. 

If a condusicHi has been reached with regard to the diagnosisi electri- 
city may be employed as our chief antineuralgic, and this must be done 
according to general principles, while the method of applicaticm will un* 
dergo yariouB little modifications according to the location of the diseased 
nerve, and the views concerning the real site of the affection. 

According to the most recent statements of JurasE, neuralgia of the 
pharynx and larynx occurs very rarely ; much more frequent are the hyper- 
nsthesia and panesthesia of these structures, which yield to similar thera- 
peutic measures. If you have convinced yourself of the absence of all 
grosser changes in the phaiynx and larynx, or have employed ineffectually 
the customary local remedies, a trial of electricity is certainly justified. 
Various methods may be tried in succession ; transverse conduction of a 
stabile galvanic current through the larynx and pharyngeal region, or a 
stabile current from the neck to the angle of the lower jaw and to the 
larynx ; or the stabile application of the An to the larynx (Ca upon an in- 
different point, for example, the dorsal vertebras). The faradic current 
may also be employed in a similar manner wiih n^oist electrodes ; a siall 
more vigorous effect may be expected in many cases from the application 
of the faradic brush to the laryngeal and pharyngeal regions, and is espe* 
cially advisable in hysterical and hypochondriacal hypersesthesia and par- 
aesthesia. An endopharyngeal or endolaryngeal application of the current 
cannot be made in such casea 

Neuralgia of ihe cardiac nerves (angina pectoris) occurs much more 
frequently and appears in many cases imder the marked form of a true 
neuralgia. But it is very difficult to determine how much is due to purely 
sensory irritation and how much to coincident motor irritation, whether 
the latter is produced in a direct or reflex manner, whether the affection 
is located in the pneumogastric or sympathetic, etc. 

Those forms and attacks will be special objects of electrical treatment 
in which the neuralgic symptoms occupy the foreground, although the 
recent observations of Ziemssen {vide page 227) also render it probable 
that we may affect the cardiac movements directly. The existence of a 
disease of the heart or great vessels does not exclude a trial vnth electricity, 
since a judicious application of the latter vfill not do any harm, but may 
perhaps exercise a palliative effect. 



SPECIAL ELSOTRO-THBRAPEUnOS. 256 

The most varied forms of apj^ioation of the eleotrioal current have 
been employed hitherto. Duohenne first used the faradio brush as a 
strong cutaneous irritant ; he faradised the cardiac region and eq>eciallj 
the nipples with strong currents and, in a number of eases succeeded in 
cutting the attack short at once ; in a few instances he produced recorery 
of the disease by the continued application of this measure. 



108. ObservaHon by Duchenne, Idiopathic cmgina pectoris. — A. tanner, 
aged fifty years, previously healthy, suddenly noticed (November 1862) a 
deep-seated burning in the mammary region and radiating pains in the 
left arm, associated with formication in the latter ; palpitation of the heart, 
oppression, feeling of terror, patient bent over forward; relief from 
venesection at the end of eighteen hours. These attacks recur upon the 
sUghtest provocation, with *(dvery movement or excitement Gradual di- 
minution of the number and violence of the attacks, but the patient was 
compelled to remain almost absolutely quiet Every movement, merely 
bending over, will produce an attack ; violent pain with a feeling of con- 
sfcriction under the lower part of the sternum, radiating into the left arm ; 
pain increased on walking. Respirations short ; violent palpitation ; 
profuse perspiration ; expression of great terror in the face, etc. Attack 
lasts eight to ten minutes. At the beginning of such an attack (April, 
1853) the strongest possible faradic current is passed through the nipple by 
means of two metalhc electrodes. Witii the terrible pain produced in this 
manner, the violent thoracic pain disappeared at once and the patient was 
forthwith in his normal condition. It now became much more difi&cult to 
produce another attack ; when this did occur finally, it was also checked at 
once by electro-cutaneous irritation of the upper sternal region. Consider- 
able improvement on the following day ; more marked exertion is required 
to produce an attack, which can be checked in two or three seconds by 
farado-cutaneous irritation of the thorax. After this day no further attacks 
occurred ; after four to five more applications (within two weeks) the 
patient was again able to work. 

Less trust should be placed in direct faradization of the cardiac region 
with large electrodes (transversely from the heart to the dorsal vertebrse), 
or in faradization of the pneumogastric and sympathetic in the neck, in- 
cluding the cervical spinal cord. 

On the other hand, Eulenburg looks for especially favorable results 
from the galvanic current, which may also be employed in various ways. 
First, the stabile application of the An directly upon the cardiac region and 
the region of the cardiac plexus (with a large flat electrode), the Ca being 
placed opposite upon the dorsal vertebrae. Eulenburg places the An on 
the sternum, the Ca on the lower cervical vertebrse. Then we may en- 
deavor to affect the large nerve-tnmks (pneumogastric, sympathetic) lying 
in the neck, either by placing the Ca upon the cardiac region and the An 
upon these nerves, or by ordinary galvanization of the sympathetic, or by the 
ascending current passing from the lower to the upper cervical ganglion 
of the sympathetic (from which method Loewenfeld recently has reported 
favorable results). At all events, it appears to me to be important to in- 



256 SLEOTBO-THEBAPBUTIOS. 

dude in the treatment the cervical cord in its entire extent, not leas also 
the medulla oblongata. Qalvanization of the sympathetic is also succeesfol 
at times in the so-called vasomotor angina pectoris, as illustrated bj 
the following case : 

109. Observation by Huebner, Angina pectoris, — ^A man aged forty-seren 
years. Suffered from dyspepsia and a feeeling of tension in the cardiac 
region after an exhausting drive. A few days afterward (March 16th), 
the first violent attack of angina pectoris, followed during the next wedc 
by one to four attacks daily, some of them very violent and lasting three 
hours ; ordinary remedies of no avail March 25th, first galvanic applica- 
tion ascending to the cervical sympathetic, then the Ca to a few painful 
points on the back, and labile and stabile upon the cardiac region, the An 
being placed over the third ganglion. Aftte this sitting the attacks 
ceased and have not since returned. 

The strength of the current must be chosen with a certain amount of 
caution ; like the duration of the sitting, it should be increased yeiy 
gradually. Eulenburg advises that active irritation of the skin should be 
avoided in those cases in which symptoms of irritation of the pneumogastric 
and paralysis of the vessels are manifested from the beginning. Recently, 
in a very severe case of angina pectoris, I observed at least favorable 
palliative effects for a number of months from galvanization of the neck 
and directly over the heart. 

As in angina pectoris, so also in neuralgia of the nerves of the stomach 
(cardialgia or gastralgia) we are equally imcertain whether the affection is 
located in the pneumogastric or sympathetic and whether it is due to 
organic changes in the stomach (ulcer, beginning carcinoma^ etc) or not 
Leube has therefore recommended electricity as an aid in diagnosis. 
However, there are not a few cases (in hysteria, neurasthenia^ chlorosis, 
etc.) in which the purely nervous character of the affection is not doubt- 
ful for a moment, and in which a trial of electricity appears indicated. 
Leube applies the An to the epigastrium, especially to its most painful 
part, the Ca in the left axillary line or more toward the spinal colunm, 
and allows a strong stabile current to pass for five to ten minute& Viz- 
ioli has recently cured a very severe hysterical gastralgia by the applica- 
tion of the An (Ca in the hand). 

110. Observation by Leube, Gastralgia, — A man, aged forty years. A 
vegetarian ; suffered for three weeks from pressure in the epigastrium, al- 
ternating vrith pain which extends to the back, disappears in the recum- 
bent position and, when very severe, is associated vrith hiccough. Eating 
has no effect ; appetite good ; no vomiting. A tender, painful point as 
large as a dollar in the region of the stomach. Diagnosis uncertain be- 
tween ulcer and gastralgia. Ghdvanic treatment ; An upon the painful 
spot in the epigastrium ; the violent pain disappeared at once. The same 
effect is produced by each repetition of the galvanization ; recovery in a 
few weeks. 



SPECIAX £L£OTBO-THBRAP£UTICS. 257 

Treatment of the spinal cord or of the sympathetic and pneomogaskic 
in the neck may be employed to advantage. Beard recommends espe- 
cially his " central galvanization " {vide page 118) as a sovereign remedy 
against nervous cardialgia. As a matter of course, direct faradization of 
the gastric region or the faradic brush to the epigastrium is also allowed 
or indicated. 

Neuralgia of the intestinal nerves (enteralgia, colic) presents the same 
characteristics as gastralgia ; very little has been determined hitherto 
concerning its treatment by electricity. It is difficult to di£brentiaia 
purely nervous colic from the other forms which are due to disease of the 
intestines, foreign bodies, worms, etc. Electrical treatment is chiefly in- 
dicated in hysterical individuals, while the most frequent form of colic» 
viz., lead colic, yields, as a rule, so readily to other measures that the 
former is unnecesaaty. 

IS, however, you desire to make a trial of this plan, the An should first 
be applied stabile to the abdomen, upon the specially painful parts or 
upon the region of the coeliac plexus and abdoYninal aorta, with a large 
flat electrode ; the An may also be applied to the spine in the region of 
the splanchnic nerves, sixteenth to twelfth dorsal vertebra), the Ca upon 
the abdomen, with quite a strong current 

These points of application are also advisable for the faradic current, 
which is introduced by means of moist electrodes ; the integument of the 
abdomen, especially the epigastrium and groins, is the most suitable 
point of application for the faradic brush or moxa. 

In lead colic it has been recently recommended to produce an evacua- 
tion from the bowels by means of strong faradic currents and thus to cut 
short an attack of coUc (one electrode introduced into the rectum and the 
other passed over the entire surface of the abdomen). 

111. Observation by Rothe. Lead colic. — A type-setter, suffering for 
six days, from violent lead colic with complete obstipation. Injections of 
morphine and the strongest drastics were useless, as were also copious 
enemata of soap and water. Treatment : a wire-shaped rectal electrode 
was introduced as far as possible, the other broad sponge electrode ap- 
plied labile to the abdominal walls and lumbar vertebrae for eight to ten 
minutes with a strong faradic current. After this application the pains 
disappeared almost entirely ; a few minutes later an enormous evacuation 
from the bowels occurred with relief from all the symptoms. 

Finally, mention must be made of the not very rare neuralgias in the 

distribution of the pelvic nerves, among which may be included an entire 

series of painful affections which are known under different terms, such as 

hypogastric, uterine neuralgia, hysteralgia, dysmenorrhcea, spermatic, tu:e- 

thral, ano-vesical neuralgia, etc. ; certain cases of vaginismus and ovarian 

hypersesthesia may also be included in this class. These maladies have not 

been studied sufficiently by electro-therapeutists, still less by gynecolo- 
17 



268 ELECTRO-THEKAPEUTICS. 

gists, in whose department these morbid processes usually fall, although 
considerable good may probably be effected in these diseases by electrical 
treatment. Neftel has made an attempt recently to investigate this sub- 
ject from a general standpoint and describes a method of galvanic treat- 
ment to which he attributes excellent results. He calls it " galvanization 
of the genito-spinol centre said of the splanchnic nerves," starting from 
the hypothesis that the therapeutic results are mainly due to the action 
upon these parts. The following is the method : the An is applied to the 
back over the lumbar enlargement, the Ca in the middle of the hypogas- 
trium, immediately above the symphysis ; a few changes of polarity are 
first made, then the strength of the current is diminished and the An 
slowly passed up and down along the entire spinal column ; the same 
procedure is then repeated with a stronger current ; then the Ca is placed 
first upon one, then upon the other inguinal region and a similar applica- 
tion of the An made, with repeated changes of polarity. This vigorous 
method is said to be specially adapted for violent attacks of dysmenorrhoaa 
and the pains are at once removed or at least ameliorated. After the ces- 
sation of menstruation, it is continued for a long time (one to three 
months) with milder currents A similar plan with the appropriate 
change in the points of application is also recommended by Neftel for the 
remaining visceral neuralgias ; he cautiously adds, however, that changes 
of polarity and strong currents were not well tolerated by hysterical 
patients. Hoist has also treated a case of dysmenorrhoea in this manner 
with favorable results. As a matter of course, pregnancy constitutes a 
counter-indication. 

The attempt may also be made to relieve these neuralgias with the 
faradic current by the two usual methods of application. Heinlein rap- 
idly relieved a spermatic neuralgia by feeble faradic currents (electrical 
hand). 

Yon Hoist has employed recently the galvanic current with success 
against ovarian hyx>ei*sesthesia, one pole (which?) being placed upon a 
painful point on the spine, the other upon the sensitive ovary. 

Under the term " rectal neuralgia " Neftel has described certain condi- 
tions characterized by great pain and disagreeable sensations in the rec- 
tum, which occur after each act of defecation and may continue many 
hours, nothing abnormal being foimd on physical examination; he has 
also treated this affection successfully by the method above described. A 
similar condition may also occur in the bladder and urethra after urination. 



VL SPASM AND CONTRACTURE 



LECTURE XXVn. 

IntEodnotion : Charaoter and Pathogenesia of Spasma; the Spastio Ohanga— Tha 
Eleotrical Izritability — Electro- therapeutio Objecta: Relief of the Direct Motor 
Irritation ; Bemoyal of Betiex Stimuli ; Production of Vigorous Inhibition; Cases 
— Electro-therapeutic Methods ; Causal Treatment ; Direct Autispastic Treatment 
and* ita Methods ; Oalvanic and Faradic ; Qeneral Plan of Treatment ; Besolta — 
Individual Forms of Spasm: Spasms of the Muscles of Mastication; Mmio 
Facial Spasm ; Blephorocpasm ; Spasm in the Distribution of the Spinal Acoe»> 
aory and in the Neck; Spasm in the Muscles of the Trunk; Respiratory Spasm, 
Singultus, etc. ; Spasms in the Upper and Lower Limbs. 

In taming to the consideration of the electro-therapeutics of spasms, 
I enter upon a field which presents certain analogies to the neuralgias, 
but is much more difficult and complicated than the latter. The study of 
conyulsions constitutes one of the darkest chapters in the pathology of the 
nervous system, and in very many of the remarkable affections belonging 
to this category we are entirely ignorant of the situation and character of 
the primary lesion of the nervous system and of the pathogenesis. 

Our treatment of these affections, accordingly, is also based upon a 
very tmcertain foundation ; Hie results are sometimes unexpectedly good, 
sometimes equally tmezpectedly negative, and, at all events, the electro- 
therapeutic success is much inferior to that obtained in neuralgias. We 
must, therefore, enter upon this field with a cautious reserve, as there is 
much room for exact therapeutical investigations. . 

We will devote, at the onset, a brief consideration to spasm in general, 
and then to those cases in which more or less localized spasms have ac- 
quired a certain independence and appear as distinct maladies, or those in 
which such local spasms are merely part-symptoms of grosser local dis- 
eases of the nervous system. I will reserve for consideration in subse- 
quent lectures those forms of spasm which have been introduced into 
neuro-pathology as so-called general neuroses, or also as central (func- 
tional) neuroses (chorea, epilepsy, tetany, paralysis agitans, etc.). 

A brief review of the nature and pathogenesis of convulsions is neces- 
sary as a foundation of electro-therapeutic method& If we define them as 
"involuntary muscular contractions, produced by pathological processes," 



260 ELEOTRO-THERAPEUnOS. 

expression is thus given to the fact that abnormal irritatiye processes — 
abnormal either from their mere occurrence or their intensity — have oc- 
ourred in the motor apparatus in the widest sense, viz., the muscles, motor 
conducting paths, motor and reflex centres. In the majority of cases, 
however, we know absolutely nothing concerning Hie nature of the nutri- 
tive or histological changes in these parts, which have either produced 
the abnormal irritative process or constantly accompany it The most 
superficial consideration teaches that the spasm is not produced by gross 
anatomical changes, since the latter are always followed by paralysis ; and 
even if we find, as is not infrequently the case, gross anatomical lesions in 
spasmodic diseases, we may always assume, with some degree of certainly, 
that they have not affected the motor apparatus itself, but are found in its 
vicinity, and thus exercise an irritant effect upon it. If spasm and juiraly- 
sis are associated in the same motor tract, it must be assumed that the 
cause of paralysis is situated in a more central portion of the path of con- 
duction than that producing spasm. We are therefore forced to the con- 
clusion that spasms in general cannot be due to severe anatomical lesions, 
but that we have to deal mainly veith finer (molecular, nutritive, circula- 
tory) changes which may be produced, it is true, in various way& And if 
we consider carefully the relations of certain spasms to their cause, the 
view is forced upon us that these causes frequently do not produce directly 
the morbid irritation in the nerves which gives rise to the spasms, but 
that the latter are induced by a special and peculiar change in the moto* 
apparatus, a sort of "spastic change," analogous to the jHreviously men- 
tioDcd "neuralgic change,'' and that this constitutes the real nature of the 
spasmodic affection and produces the individual spasms. But these are 
merely more or less plausible surmises. 

With regard to the pathogenesis of these pathological stimuli we may 
say that they owe their development either to an abnormal intensify ci 
the stimulus or to increased excitability of the motor apparatus. In very 
many, perhaps the majority of cases, it vfill not be possible to separate 
sharply these two factors, and not infrequently they will be associated 
vnth one another. But at all events it is more probable that the increased 
excitabiUiy plays a more important part in the pathogenesis of oonvakions 
than the increase in the intensity of the stimulus, and that what I have 
just described as " spastic change " of the motor nerves may not diffiar 
very greatly from such an increased excitability. But we still possess no 
knowledge as to what the character of this irritative process must be in 
order to produce the various forms of convulsions (tremor, spasm, tetttaii% 
contracture, clonic convulsions, etc.). 

The abnormal irritative process may act directly upon the motor appa- 
ratus, as upon the muscular fibres themselves and the motor terminal 
plates (fibrillary contractions, certain forms of contracture), or upon the 
peripheral paths of conduction (from neuritis, injury, etc.), or upon the 



SPECIAL ELEOTBO-THERAPBUnOS. 261 

moicnr paths of conduction and the central apparatus of the spinal cord in- 
cluded in them (in myelitis, spastic spinal paralysis, eta), or, finally, upon 
Ae hndn (apoplexy, tumors, inflammation, etc.) in various parts, from 
irritation of the conducting-paths as well as the centres. In illustration 
€d this I will merely mention Nothnagel's convulsive centre in the pons 
and the recent experiments upon the cerebral cortex. 

On the other hand, the irritative process in spasms is not infrequently 
produced indirectly, most frequently in a reflex manner, either by an ab* 
ncMrmal condition of irritation in the sensory terminal apparatus and paths 
(as in disease of the sensory nerves thenuselves, in irritation of surfaces 
rich in nerves, the skin, mucous membranes, retina, etc.), or by an abnor- 
mally increased irritabiliiy of the reflex centres in the spinal cord and 
brain, which will convert the normal physiological stimuli into spasmodic 
centrifugal irritations (as in myelitis, tetanus, etc.). 

To what extent, finally, the inaction of inhibitory mechanisms may be 
made responsible for the pathogenesis of convulsions, will not be consid- 
ered closely, since our previous knowledge of the situation, character, and 
mode of action of these mechanisms would be insufficient to exert a deci- 
sive influence upon our electro-therapeutic measurea I will merely add 
that the existence of a general neuropathic disposition or affection will aid 
considerably in the production of spasms, even of many local ones, and 
that without such a favorable predisposition very many local spasms would 
not be jnroduced by certain exciting causea This is true of a general 
neuropathic taint, of hysteria, neurasthenia, anaemia, chlorosis, and per- 
haps of other conditions which enfeeble the nervous system ; this feature 
nrast be carefully considered in treatment. 

This is naturally not the place to enter, even in brief, upon the symp- 
tomatology and diagnosis of individual forms of spasm. But I will not 
<miit to state that^ for a successful therapeutics and the development of 
therapeutic indications and methods, it is indispensable to obtain the most 
accurate knowledge concerning the neuro-muscular tracts affected by the 
spasm (very grave errors not infrequently occur, for example, in mistaking 
the side of the body affected by the spasm, as in spasm of the muscles of 
the throat and neck) ; to endeavor to ascertain, as far as possible, whether 
the spasm is produced in a direct or reflex manner ; to determine, in the 
first event, the exact site of the lesion with all our diagnostic aids ; in the 
other event, to determine with great care the sensory nerve tract from 
which the morbid irritation proceeds. In this respect I will remind you 
especially of the spasm-producing or spasm-inhibiting pressure-points dis- 
covered by Qtaefe, Eemak, and others, and which possess such great im- 
portance in electro-therapeutioa 

Unfortunately I am compelled to say that electrical examination has 
hitherto contributed little or nothing to the elucidation of these important 
points. In very many, especially in pure cases, no change is discovered 



262 ELEOTBO-TB^EBAPBUnOS. 

in the electrical excitability ; in complicated cases changes occasipnallj 
occur which are connected with the accompanying paralysis and have noth- 
ing to do with the spasm as such. There is no change which is peculiar 
to spasm, and even with a careful qualitatiye examination there are very few 
cases in which we can detect the anomaly which is most to be looked for, 
viz., increased electrical excitability. This has been observed with great 
regulaiity in tetany since the change was first pointed out by me ; I have 
been unable to corroborate this observation with regard to chorea. At 
all events, other and finer methods of examination are necessary in ord^ 
to determine any changes which may be characteristic of spasm. The 
apparent diminution of electrical excitability, which is found not infre- 
quently in contractured neuro-muscular tracts, because feeble stimuli can- 
not find any expression in the already contracted muscles, must not be re- 
garded as a real diminution. It is occasionally possible to demonstrate 
{x>ints of pain and pressure by means of the electrical examination ; in 
difficult cases this examination should not be omitted (Ca upon the spine, 
the plexus, etc.). 

After these introductory remarks you will have formed some idea ot 
the objects to be effected by electro-therapeutics. In the first place, the 
removal of the direct motor irritation ; this may be done by diminution 
of the excitability, by anelectrotonus of the motor apparatus, i.e., by the 
modifying effects of electrical currents ; or by the removal of pathological 
irritants from the neighborhood of the nerve (congestion, inflammation, 
cicatrices, eta), for which purpose the vaso-motor and catalytic actions of 
the current are resorted to ; or we endeavor to utilize both categories of 
actions, in order tp abate the hypothetical molecular or nutritive disturb- 
ance in the motor nerves, the spastic change. 

The second object consists in the removal of the reflex irritants pro- 
ducing the spasm ; these should be treated in the same manner as neu- 
ralgias and other conditions of sensory irritation, t.e., by means of the 
modifying and catalytic actions of the current ; to this category belongs 
also the treatment of certain pressure points, which is so useful in many 
cases. 

Finally, we still possess another means of relieving convulsions, viz., by 
the production of vigorous inhibition, by which the motor irritative pro- 
cess is suppressed ; this is done by the aid of strong peripheral sensory 
irritation, i.e., by the stimulating action of the current. 

You will soon learn that this latter method is also occasionally avail- 
able for the production, by means of over-stimulation, of a sort of exhaus- 
tion of the motor apparatus, and also in order to relieve secondary nutri- 
tive disturbances (shortening, atrophy, etc.) which develop occasionally 
in muscles that have long been the site of spasm. 

It also goes without saying that the most varied actions of the oar- 
rent may be utilized in meeting the causal indication, t.e., the removal of 



SPECIAL ELEOTBO-THEBAPEUTIOS. 263 

the primary affeotion which has giyen rise to the spasm, such as neuritis, 
myelitis, gray degeneration, hysteria, neurasthenia, etc. This coincides 
not infrequently with the direct antispastic treatment 

Despite the numerous aids with which the electrical current seems to 
furnish us, the electro-therapeutics of convulsions presents much greater 
difficulties and uncertainties than that of neuralgias. The results are by 
no means so brilliant and certain, and often depend more upon chance 
than upon the skill of the electro-therapeutist. 

However, literature and practical experience furnish numerous exam- 
ples of favorable results from the electrical treatment of the most varied 
forms of spasm. The following cases will serve as illustrations of the dif- 
ficulties of treatment, as well as of the different methods of electrical ap- 
plication. 

112. Personal observation. Left facial spasm {convulsive He). — A man, 
aged forty-eight years. Suffering for ten days from mimic facial spasm of 
the left side, occurring in numerous typical attacks ; it developed suddenly 
without known cause. Glalvanic treatment : An stabile upon the pes anse- 
rinus, stabile from the nerve-trunk to the muscles ; later, galvanization of 
the sympathetic. After twelve sittings the affection grew somewhat worse. 
Treatment then intermitted for two months, slow improvement, eight to 
ten attacks daily. Qalvanic treatment then resumed ; in the next ten days 
attacks increased to twenty-five a day. Then injections of morphine for a 
month without effect. Then application of increasing faradic currents ; 
after the fifth sitting, attacks reduced to five or seven per diem ; after the 
twelfth sitting three attacks occurred during the next few days, and they 
then ceased entirely. 

Patient remained well for two years; in March, 1870, it reappeared, 
twenty to thirty attacks daily. Treatment was now begun with increasing 
faradic currents ; no improvement in the next six days. Then galvanic 
treatment with An stabile ; disease grew worse after fifteen sittings. Then 
increasing faradic currents again ; stationary after ten sittings. Then io- 
dide of potassium for three weeks, then bromide of potassium ; improve- 
ment ; six to seven attacks daily. Increusing faradic currents were again 
employed during fourteen sittings, with no result. After administration of 
large doses of valeriante of zinc the spasm ceased at the end of two weeks. 

January, 1873, disease reappeared ; three to six attacks daily. Various 
methods of electrical treatment had no noteworthy effect. 

113. Personal observation. Bilateral mimetic facial apasm (blephorospasm), 
— A man, aged twenty-four years. Suffering for three months from 
marked winking, associated with a burning sensation in the eyes and 
photophobia ; gradual increase to violent facial contractions. The affec- 
tion had been improved by ophthalmological treatment Status on No- 
vember 16th, 1870 : frequent attacks of bilateral mimic facial spasm ; first, 
repeated vigorous contraction of the orbicularis palpebrarum, then opening 
of the eye, vigorous spasmodic contraction of the frontal muscles and 
those around the mouth. Attacks occur every two or three minutes. 
Galvanic treatment: An stabile to the eyes (Ca in the neck), then An 
stabile to plexus anserinus on both sides. Considerable improvement 
on following day ; cured after fifth sitting. 



264 ELECTBO-THERAPEUTICS. 

March, 1873, patient retamB with same affection, which had begun 
three months previously, after a long walk in the snow ; attacks not so 
violent as formerly. Oalvanio treatment (same as before) produced re- 
covery in two sittings. 

114. Personal observation. Left mimetic facial spa^nu — ^A woman, aged 
twenty- three years. Was operated upon in 1866 for strabismus of left eye 
In spring of 1867 twitchings of left side of face began, and gradmdfy 
increased in severity, especially during excitement. The spasm affects 
chiefly the muscles around the left eye and in front of the superior maxiUa. 

November, 1867. Galvanic treatment ; An stabile on the plexus anae- 
rinus and behind the ear. Considerable improvement after thirty sittingB, 
and final recovery. 

115. Ob.^ervation by Moritz Meyer. Clonic spasm of the facial mttsdes. — 
A man, aged thirty years. For several months gradually developing right 
mimetic iacial spasm, especially in the orbicularis palpebrarum and the 
muscles in front of the ear ; many attacks doily. Pressure upon small 
painful swellings over the transverse processes of the third and fourth 
cervical vertebrsB (on the right side) checked the spasm at once. Gkdvanic 
treatment : application of An (ten elements) to these spots ; ahnost com- 
plete recovery after thirty-seven sittinga After an attack of pnemnonia 
a relapse occurred, but was entirely cured in twenty-three sittii^^ 

116. Personal observation. Spasm of the right splenius muFde, — ^A 
woman, aged forty-five years. Suffering from this spasm for three months 
as a result of great excitement It was preceded by rheumatoid pains in 
ihe occiput and neck ; the head always drawn to the light side ; sleep 
disturbed thereby ; no rehef from injections of morphine. Careful exam- 
ination showed that the spasm affected the right splenius muscle. It 
occurs especially during movements ; interferes with work ; now ceases 
during sleep. Patient anaemic, otherwise healthy. Galvanic treatment : 
An stabile upon the muscle and the neck on the right side, then stabile 
transversely and obliquely through the head. Distinct improvement after 
four weeks' treatment, but no further progress thereafter. Faradic cur- 
rents of increasing strength are then tried ; considerable improvement in 
three weeks ; spasm, in a mild degree, only occurs while waUdng. 

117. Observation by E. Remak, Spasm of the neck mtiscles, — A woman, 
aged fifty-two years. Suffering nearly three years from very severe spasms 
of the neck muscles (chiefly in the distribution of the right spinal acces- 
sory, but also in the splenius, biventer, etc., together with spasmus nictitaiw 
and spasmodic roUing movements of the eyeballs). Patient had be^i cured 
of a similar affection seventeen years previously by galvanization of the 
right transverse processes of the cervical vertebrae. Then remained well 
for fifteen years. Recent galvanic treatment had no eftect. But a favora- 
ble result was again obtained by anodal applications to the right trans- 
verse processes of the cervical vertebree with a moderately strong stabile 
current ; very marked improvement was effected in eighty-four sitttings. 

118. Observation by Moritz Meyer, Clonic spasm of individual nedt 
muscles, — A woman, aged twenty six years. Suffering for a long time 
from spasmodic movement of the head to the left and posteriorly, asso- 
ciated with creaking in the region of the lower cervical vertebrae and 
various spasmodic twitchings in the limbs. Examination showed abnor- 
mal tension of the muscles in the left upper part of the neck ; transverse 
processes of middle cervical vertebr.e on left side tender on pressure. 
Spasm almost constant, very distressing. Treatment : stabile application 



SPECIAL ELECTRO-THERAPEUTICS, 265 

of An to left upper part of neck, Ca in the submaxillary fossa, for ten 
minutes, an assistant with difficulty holding the head. In four weeks the 
patient could hold the head in normal position without assistance for a few 
seconds ; after one hundred and seventy-five sittings improvement so fat 
advanced that patient could go to a watering-place. Later recovery. 

119. ObseracUion by Erdniann, Rheumatic torticollis, — A merchant. 
Suffering for four months from rheumatic torticollis ; head turned to the 
right, forward and downward, chin approximated to right shoulder. Pas- 
sive movements painf uL Faradic brush to neck rendered movements of 
head more free for several houra This, together vnth direct faradic 
stimulation of left splenius produced recovery in ten sittings. 

120. ObaervatioH by M. Rosenthal, Rheumatic torticollis. — ^A woman, 
aged thirty years. Suffering, as the result of exposure, from contracture 
of the right trapezius ; head drawn to the right and backward, chin 
turned to the left Passage of galvanic current through the muscle pro- 
duced more free mobility of head. Eecovery after second sitting. 

121. Observation by Moritz Meyer, Rfieumatic contracture of the levator 
anguli scapulas, — ^A girl, aged twelve years, as the result of a cold, was 
affected with contracture of left levator anguli scapuhe, the belly of which 
was very distinct Immediate relaxation after passage of current with a 
few changes of polarity. Complete recovery after third sitting. 

122. Personal observation. Nervous pertussis. — ^A girl, aged twelve 
yeara Has had spasmodic attacks of coughing for six months, occurring 
every few seconds as a hoarse, toneless cough, associated with slight 
twitchings in shoulders and lips ; complains of pain in laryngeal region. 
Also suffers from migraine. 

Faradization of hanyx for two days ; disappearance of pain, but cough 
unchanged. Then galvanic treatment : stabile, transversely through the 
lamyx and from neck to lamyx. Very rapid improvement ; cough disap- 
peared in five day& Patient returns home and disease reappears in few 
days. Comes under treatment four weeks later ; after four days cough 
disappeared luider galvanic treatment, which was continued a few weeks ; 
recovery. 

12^ Obaervation by M, Meyer. Singultus, unth weakness qf the left arm. 
— A very nervous man, aged forty years. Weakness of left arm, sixteen 
years ago, after severe exertion, associated with feeling of constriction in 
left side of thorax and frequent eructationa Pressure on spinous process 
of seventh cervical vertebree produces pain and violent singultus, occurring 
about twenty times every half minute ; transverse processes of third to 
fifth cervical vertebrsB also tender on pressure. Anodal treatment of these 
points produced improvement forthwith, and almost complete recovery 
after nine sittinga 

124 Personal observation. Spasm of both recti abdominis and latissimi 
darsi, — A woman, aged twenty-four years, very anffimic. Suffering for a 
year and a quarter from spasmodic twitchings in the abdomen, painless, 
but increasing in frequency and severity, l^equent intermissions lasting 
several days. Examination shows isolated, short, lightning-like contract- 
ions in both recti abdominis, with synchronous but weaker contraction in 
both latissimi, and slightly also in the pectorales majores. The spasm pro- 
duced by pressure and a slight blow upon the abdomen. No indications 
of hysteria. Stabile passage of galvanic currents from the dorsal spine to 
the epigastrium produces a noteworthy improvement 

126. Observation by Moritz Meyer, Tremor of the right arm. — ^A boy 



266 ELEOTBO-THERAPEUTICS. 

aged fourteen years. Suffering for two years from gradually increaaing 
tremor of the right arm. Stabile galvanic current, ascending from the 
radial nerve to the plexus, labile galvanization of the extensors in the fore- 
arm. Distinct improvement after three sittings ; recovery after nineteen 
sittings. 

126. Personal observation. Clonic spasm of the lower limb as the result 
of an articular neurosis.— An officer, aged twenty eight years. Nervous 
temperament. July, 1866, struck by a spent ball upon inner side of left 
tarsus ; inflammation and swelling of the entire leg, followed by pain and 
tenderness in left knee, in which t traumatic inflaiLation had 'bieTpres. 
ent fourteen years previously. Pain prevented patient from walking or 
standing upon left foot Later, twitchings in muscles of calf and thigh, 
more violent upon flexion of the knee ; ideep disturbed by twitchinga 

August 30, 1866 : left leg stiff ; knee-joint slightly swollen, veiy tender 
on contact; fibrillary and clonic contractions in calf and thigh, much more 
vigorous upon touching the patella and upon every attempt at flexion. 
Galvanic treatment : An stabile upon the knee-joint for two to three min- 
utes, then descending stabile through the crural and sciatic nerves for 
three to four minutes, later through the lower part of spine. DiBcharged 
cured after eighteenth sitting. 

127. Observation by B, Remak, Heniiplegic contracture.— In a patient 
suffering for two years from hemiplegia and contracture, a primary faradic 
current was passed through the contractured flexor of the forearm ; im- 
mediately afterward the hand could be opened passively and the ficgers 
extended. In ihe same patient relief of the contracture was obtained in a 
remarkable manner by the application of descending galvanic currents 
tiirough the nerves of the contractured flexor muscles. Voluntary power 
over ^e paralyzed muscles increased at the same time. 

128. Observation by R. Remak. Rheumatic contractures. — A woman, 
aged forty-nine years. Suffering for seventeen years from chronic articular 
rheumatism of the upper limbs ; contracture of the flexors from the 
shoulder to the hand. A galvanic current was passed for six minutes 
through the muscles of the right shoulder and arm. Forthwith the pa- 
tient raised the arm higher than she had been able to do for the past 
seventeen years. On the following day the patient reports continued im- 
provement. Muscles of forearm and hand treated in same way with simi- 
lar result, and this was afterward obtained in left arm. 

129. Observation by BaerwinJcel. Contracture in compressUm-mydiHs. — 
A boy, aged six years. Suffering from paraplegia due to caries of the ver- 
tebrae ; presented paralysis and ansBsthesia of the legs, greatly increased 
reflexes, flexor contracture at the knee, extensor contracture in the foot 
Strong galvanic current, stabile from the upper surface of the kyphosis to 
the coccyx produced immediate relaxation in the joints of the foot so 
long as the circuit was closed and for a few moments thereafter. Knee 
and hip joints were not affected thereby. 

130. Observation by Leloir. Hysterical contracture. — ^A woman, aged 
twenty-two years. Suffers from anaesthesia of left hand and forearm, left 
ovarian hypersesthesia, and an hysterical contracture of left hand, which 
had lasted two months ; the latter was cured in eleven days by permanent 
application of a feeble galvanic current of five to ten elements daily for 
six hours. 

131. Observatio7i by Moritz Meyer. Reflex contracture of the quadratus 
lumborum. — A man, aged thirty-three years. Suffering since Februaiy, 



SPECIAL ELEOTBO-THERAPEUnOS. 267 

1879, from weakness of left knee and ankle joint ; also swelling of left hip 
and dorsal muscles. Slow improvement, then relapse, curvature of spine 
to left, so that an iron corset and cork sole in right shoe became necessaiy. 
Scoliosis of lower dorsal and lumbar region appears due to very firm con- 
tracture of left quadratus lumborum. Passage of galvanic current through 
the muscle had no noticeable effect, but this occurred at once upon appli 
cation of one pole to the quadratus, the other to the sacrolumbalis, with 
changes of polarity of a strong galvanic current (forty to fifty elements). 
Improvement was striking, and the scoliosis had disappeared almost en- 
tirely after fourteen sittinga 



In the selection of the electro-therapeutic method the removal of any 
palpable lesion of the nervous system, which may be present, must first be 
thought o( %.€., the causal indication must be met This is done by the 
electrical treatment of any demonstrable organic disease of the brain, 
spinal cord, or peripheral nerves, according to well-known methoda There 
can be no doubt that such procedures are often attended with good results, 
and it is a pity that in so many cases a causal affection cannot be demon- 
strated with certainty. 

As a rule, the direct antispastic actions of the current must be resorted 
to, but you will often be embarrassed as to the position in which the elec- 
trodes should be applied — whether upon the muscles themselves, the pe- 
ripheral motor nerves, spinal roots of the nerves, spinal cord or brain, or, 
indeed, upon remote parts, points of pressure, sensory nerves, etc. We 
are not often in a position to decide this question with any degree of prob- 
ability, and we must then make systematic experiments until the proper 
locality has been found. 

The individual methods of antispastic treatment coincide, in the main, 
with those of antineuralgic treatment. The galvanic current, especially 
the stabile application, is mainly employed for the production of modify- 
ing and catalytic effects upon the motor nervous apjmratua The anode is 
placed upon the nerve-trunk (or the spinal cord or brain, or whatever 
point you desire to influence) and allowed to act stabile for some time, 
beginning with a very feeble current, gradually increasing, and, after re- 
maining at this degree of intensity for some time, gradually diminishing 
it If the anodal application is ineffectual, trial may be made of the 
cathode in the same manner, as this possesses, perhaps, other catalytic 
actiona Descending stabile currents through the motor nerves act in a 
similar manner, but the ascending current is said to be more efficient at 
times ; furthermore, R Bemak states that he has had similar &vorable re- 
sults from frequent interruptions of a descending current passing through 
the nerves and muscles, especially in tonic reflex spasms. The fact ob- 
served by Banke, that galvanic currents of a certain intensity, when passed 
through the spinal cord, inhibit the reflex spasms of strychnine poisoning, 
perhaps has its analogue in the favorable results obtained in man by Baer 



268 ELECTBO-THSBAPSUnCS. 

winkel {vide Observation 129). The direction of the current i^jpetis to be 
immaterial if its strength is sufficient 

Antispastic effects may also be produced by the faradic ciirrenia» 
either by passing feeble faradic currents (with moist electrodes) throu^ 
the motor apparatus, perhaps also through the head and spine ; or by 
strong faradic currents through the peripheral nerves and musdea Start- 
ing from the physiological fact that the dilatability of the muscles increases 
while they are being strongly faradized, Eemak first employed such cur- 
rents, with success, for the relief of paralytic contracture& The appUca- 
tion of gradually increasing and diminishing faradic currents is probably 
the best method of producing such effects. 

It has not been ascertained whether these procedures act by overstim- 
ulation and consequent Exhaustion of the motor apparatus, by a change 
in the nutritive processes, or by diminution of excitability. 

A second method of treating convulsions is the removal of periphenl 
irritants in so-called reflex spasm& Recourse is had to the methods 
customary in neuralgia and other conditions of sensory irritation, ue^ 
mainly to the application of stabile galvanic currents, etc, upon the 
sensory nerves. To this category also belongs the electrical treatment 
of pressure-points or of sympathetic tracts and ganglia. A stabile anodal 
application should first be made to these points ; its action is sometimes ex- 
hausted after a certain length of time, and other points must then be sought 

Finally, the last method, which sometimes x^roves successful, is the 
production of inhibitory action by means of very severe peripheral irrita- 
tion ; this may be done either by removing sensory reflex irritants (as in 
neuralgia), or by the direct inhibitory effect of a vigorous stimalus upon 
motor irritation. For this purpose the feradic brush or the moxa is 
applied to various parts of the skin in the immediate neighborhood o^ 
or remote from, the affected motor nerves, uix>n the spinal column, or in 
the epigastrium ; in some cases it is useful to stimulate ix>ints of pressure 
either with the faradic brush or the stabile Ga^ when irritation of these 
points stops the spasm. 

I will mention in conclusion that, in old rheumatic and other con- 
tractures, faradic excitation of the antagonists of the contractured musdes 
is sometimes resorted to in order to improve the contracture, detormHj^ 
and mobility of the parts. It goes vrithout saying that this is merely a 
form of electrical orthopsBdics and gymnastics. 

In paralytic contractures the treatment of the paralysed antagoiiislB 
not infrequently benefits the contracture, since it is erident thai) the re^ 
toration of voluntary power over the paralyzed muscles is the beat mtatis 
of antagonizing the contracture which has resulted in co moqa snee <i 
such paralysis. 

It is thus evident that a large number of methods of eleektoal treeW 
ment against spasm are at our command, and it is often difScult to make 



SPECIAL ELEOTBO-THSBAPKUnCS. 2t)9 

a choice. As a matter of course yoa will select the method according to 
"well-kiiown tules and the peculiariiy of the indiyidual case, but yon must be 
prepared for fiulure and the neceesiiy of trying a number of other methods. 
As a general plan of treatment I would recommend that a careful search be 
made for causal affections, and for the true localization of the disease, and 
that these be made the first point of attack ; furthermore, great care should 
be exercised in the determination of reflex irritants and points of pressure, 
since cases in which these are found present more favorable chances for 
treatment. In the direct treatment I would recomn)^nd beginning with 
the mildest measures, such as stabile anodal application, and then passing 
to descending stabile currents, simple or increasing ^uradic currents, then 
to the faradio brush, and finally to changes of polarity. A method which 
fiuled at first may prove beneficial at a later period. 

The intensity and duration of the applications depend upon individual 
cbronmstances ; it is always advisable to begin with weak currents and 
short sittings, and gradually pass to more vigorous applications, per- 
haps repeated several times a day. The duration of the entire treatment 
must sometimes be very protracted. According to Bemak the treatment 
riiould be stopped and the complete recovery left to nature after the 
q>asm has been relieved with the exception of slight tracea You should 
always be prepared for relapses, which occur very readily and frequently, 
often after very long intermissions. 

The results of electro-therapeutics in convulsions are extremely un- 
oertain ; they are sometimes surprising and brilliant, at other times the 
obstinacy of the afildction drives physician and patient to desperation. 
Hardly any general statements may be made with regard to the prognosis ; 
rfaeumatio muscular contractures, and the spasms produced by cold, 
neuritis, traumatism, and the like are relatively &vorable ; especially 
favorable are reflex spasms and those forms which are associated with 
distinct points of pressure; very obstinate are those due to a severe 
neuropathic diathesis, frequently relapsing spasms, and those occurring in 
organic diseases of the spinal cord and brain, while functional central 
spasmodic diseases present a better prognosis. 

In the discussion of the individual forms of spasm I may confine 
myself to a few practical details. 

Spasm of the muscles of mastication (in the tonic form as trismus, in 
the clonic form as gnashing or chattering of the teeth) very rarely occurs 
as an isolated aflSBction ; more frequently it is a part-symptom of general 
forms of spasm. The isolated forms occur sometimes from a direct affection 
of the motor root of the trigeminus, more frequently in a reflex manner 
(irritative conditions in the distribution of the trigeminus, affections of 
the teeth, disease of the temporo-maxillary joint, peripheral injuries, 
worms, etc). The electrical treatment varies accordingly ; it presents no 
peculiarities and may be applied in different ways. 



270 ELEOTBO-THEBAPEUnOS. 

The most frequent of all forms of spasm is mimetic &cial spasm, a 
convulsiYe tic in all its yarious forms, such as partial or diffuse, tonic or 
clonic spasm, occasionally also in the form of slight contracture (after 
facial paralysiB). It may arise from various causes ; those forms aie 
usually the worst in which no cause can be ascertained and in which the 
tic persists for years. Peripheral and central diseases haye been recog 
nized occasionally as causes ; recently the yiew has been entertained that 
a portion of the '* idiopathic " clonic facial spasms are due to an affection 
of the cerebral cortex in the region of the so-called facial centre. 

The electrical treatment requires judgment and patience; all the 
yarious methods may be employed and must be resorted to sometimes 
in succession, yiz., stabile, application of the An with increasing and de- 
creasing strengths of current upon the plexus anserinus or upon ihe 
trunk of the facial nerye behind the ear ; transyerse conduction of the 
current through the mastoid processes (An upon the affected side) ; 
stabile application of the An upon the opposite parietal region oyer the 
facial centre (lower half of the central conyolutions, tnde Fig. 29, page 
122) ; the "large head electrode " placed upon the well-moistened scalp 
will serye as the An (Ca upon the spine or the opposite hand), the cur- 
rent being applied stabile, of moderate strength, for fiye to ten minutea 
You may also employ descending stabile currents in the indiyidual nerye 
branches, or frequently repeated cathodal closures or changes of polarity. 
If points of pressure are found (upon the spine, in the face, the buccal 
cayity, behind the ear, etc.) they must be made the subject of anodal treat- 
ment ; in seyere cases do not omit applications to the indiyidual ganglia 
of the ceryical sympathetic, especially if they are tender on pressure. 

Increasing faradic currents may also be applied to the neryes, not 
infrequently with good effect ; likewise faradic currents transyersely and 
longitudinally through the head or the cortical centres ; finally, trial may 
be made of the faradic brush appHed to the integument of the neck, the 
posterior auricular region, or to any painful points which may be present 

Partial facial spasm, especially the so frequent blepharospasm, is 
treated in an entirely analogous manner ; anodal application to the closed 
lids and the region of the supra-orbital nerye, and then, aboye all, the 
treatment of points of pressure which play such an important part in these 
forms ; likewise, galyanic treatment of the sympathetic and its indiyidual 
ganglia. 

Spasms of the tongue and of the ocular muscles are yeiy rare and may 
be treated according to general principles. 

On the other hand, spasms in the distribution of the spinal accessory 
nerye and in the other muscles of the neck are not at all infrequent and 
are yery annoying to the patient. They present the greatest analogy with 
true conyulaiye tic, and may be treated in the same manner. Tins 
category includes spasms in the sternocleidomastoid, trapezius, splenius^ 



SPECIAL ELECTRO-TRBBAPEUTICS. 271 

rotatores oapitis, levator anguli scapulae, and the other deep muscles of 
the neck and throat, and their symptomatology and diagnosis may be 
studied in the treatises on neuropathology. The anodal treatment of the 
neck, spinal accessory nerve, and cervical sympathetic, recently recom- 
mended by K Bemak, should be tried first; in addition I apply the 
anode usually to the cerebral cortex on the opposite side, and an applica- 
tion may also be made to the medulla oblongata (transversely through 
the mastoid processes). If ix>intB of pressure are present, these should 
first be treated. 

Tonic spasms also occur very often in these muscles ; they are ob- 
served not infrequently in their recent form as rheumatic torticollis, and 
then offer a very favorable object for electrical treatment {vide Observations 
120 and 121). A few sittings (An stabile or changes of polarity, or 
vigorous faradization) are usually sufiicient to reheve the affection. But 
this is effected with much more difficulty in the congenital forms, or those 
which have passed into permanent contracture. In such cases every 
method is often tried without avail, and, at the most, some good result is 
obtained from the regular (gymnastic-orthopaedic) faradization of the 
antagonists. 

This holds true of spasms and contractures in the other muscles of 
the trunk (the back and abdomen) which may occur in the most remark- 
able forms and combinations, and usually present the greatest difficulty 
even to clinical examination and interpretation. Electro-therapeutics 
possesses few triumphs among these forms of spasm ; their treatment is 
carried out according to general principles, and consists, in the main, of a 
more or less premeditated experimentation with the most various methods 
in all possible parts of the peripheral and central nervous system from 
which the spasm may proceed. 

Mention should be made also of spasms of the respiratory muscles, in- 
spiratory and expiratory spasms, singultus, etc., since they fall occasion- 
ally into the domain of electro-therapeutics. These spasms, which are by 
far the most frequent in hysterical persons, affect either the diaphragm 
alone or the entire respiratory mechanism, or inspiration or expiration 
separately, or various expiratory acts, such as coughing, sneezing, cry- 
ing, laughing, etc. In tonic spasm of the diaphragm, an extremely rare 
affection, success has been obtained sometimes by the vigorous applica- 
tion of the faradic brush to the epigastrium in the region of the dia- 
phragm ; also from faradization or galvanization of the phrenic nerves in 
the neck. The same method is also adopted in clonic spasm of the dia- 
phragm (hiccough), which is very obstinate and annoying occasionally and 
demands active treatment I have seen brilliant results in such cases from 
the application of the faradic brush to the epigastrium, and others report 
similar effects from faradization or galvanization of the phrenics ; in some 
cases, anodal treatment of the neck or transverse conduction through the 



272 SLEOTBO-THEBAPEXTnOS. 

mastoid processes may proTe serviceable ; likewise a vigorous stimiilatioD 
of the distribution of the superior laryngeal nerve. ELeotrical treatix»&t 
is generally useless in the complicated forms of respiratory spasm (inspizm- 
tory and expiratory spasm, sneezing, yawning, laughing, crying spasms, 
etc.). Some good result may be obtained, perhaps, if the causal indica- 
tion (hysteria, peripheral irritation, ovarian hypersesthesia, etc.) requires 
electro-therapeutic measurea The same methods may be employed 
directly in these spasms as in spasm of the diaphragm. 

Spasms in the muscles of the upper limbs are very common ; as a mis, 
indeed, they usually form part of more widespread forms of spasm and 
other neuroses (chorea, tetany, hysteria, paralysis agitans, qpilepsy, etc), 
or they constitute a symptom and sequela of severe local central dinonms 
(as in hemiplegic contracture, post-hemiplegic chorea and athetosis, par- 
tial cortical epilepsy, contracture in spinal affections, etc), and often re- 
quire no other treatment than that of the primary disease Som^anMS, 
however, the spasms develop locally in the upper limb, from xranritss of 
individual nerves, joint affections, neuralgias, etc 

As a matter of course, it is necessary that the primary affectum be 
treated first, and the often-mentioned antispastic methods may then be 
applied to the nerves and muscles of the arm, to the neck and throat, 
to painful points in the brachial plexus or the spinal column, etc ; anodal 
application to the neck and brachial plexus is the main feature of ibe 
treatment. The various methods to which I have previously refeired 
(descending stabile galvanic currents, or frequently interrupted galvatiic 
currents or changes of polarity, or vigorous &radization with coincident 
extension of the muscles, etc.) are employed in idiopathic or secondaiy 
contractures. Applications to the cortical centres should be tried in par- 
tial clonic spasms due to cortical lesions. 

The same statements will hold true, mtUaiis mtUandis, wiih. regard to 
f^)asms in the lower limbs as with regard to those in the upper. In ihe 
large proportion of cases they form part of general diffuse varieties of 
spasm or they are symptomatic of central diseases, especially of diseases 
of the spinal cord. Purely peripheral spasms, reflex spasms from diseases 
of the joints, neuralgias, foreign bodies, etc., also occur occasionally ; very 
frequently, paralytic and hysterical contractures and the so-called cramps, 
particularly in the muscles of the calves. 

The selection of the method of treatment is based on general psm* 
dples ; further details are imnecessaiy. 



VIL ANJSSTHE8IA. 



LECTURE XXVnL 

Ohanoter and PftthogenetiB of Axuaathesia— Electrioal Examinl^on— Objeote of El69* 
tro-therapeatios ; Gases — Methods of Eleotrioal Treatment : Causal Treatment ; 
Direct Treatment of Anssthesia ; Methods with the Faradio and Galvanio Oar- 
rents; Belief of Secondary Trophio Distorbanoes ; Results — Indiyidoal Forms: 
AnasthesiA of the Trigeminus, the Phaiynx, and Larynx ; Vasomotor An»sthe- 
•ia ; Hysterioal Anasthesia ; Ataxic Anasthesia. 

Ik the same maimer that spasms and their treatment present certain 
analogies to neuralgia, so ansesthesia possesses intimate relations ^th 
paralysis. It is due to similar, Terj often to identical lesions and its 
electrical treatment is carried out according to the same principles. But 
the anatomical and physiological conditions of the centripetal paths of 
conduction bring it about that we have to deal with relatively simpler 
therapeutic objects than in paralysis, so that the methods of treatment are 
correspondingly simpler and more uniform. 

Ansesthesia refers to a diminution or abolition of the sensations con- 
Tcyed to consciousness through the sensory nerves and the nerves of 
special sense. I now refer in the main to cutaneous and muscular anses- 
thesia (special sense and visceral ansesthesia will be discussed at a later 
period). This disturbance of function may be due to a diminution of the 
irritability of the peripheral or central sensory terminal apparatus or to 
an inhibition and interruption of the processes of conduction in the sen- 
sory nerve tracts (conduction ansesthesia). The latter constitute by far 
the most frequent and important forms of ansesthesia, and are the almost 
exclusive objects of electrical treatment 

The occurrence of ansesthesia from an exclusive affection of the pe- 
ripheral sensory terminal apparatus (in the integument, tendons, muscles, 
joints, etc.) has not been established sufficiently, since implication of the 
adjacent finest sensory paths of conduction cannot be excluded, as in the 
usually slight ansesthesias due to cold (ether spray), heat, caustics (lye^ 
carbolic add, etc), ischsemia (vasomotor neurosis), etc 

Nor is the occurrence of anaesthesia from an exclusive affection of the 

central receptive apparatus established with certainty. It is surmised, 
18 



2 74 ELEOTBO-THERAPEUnCS, 

indeed, that this apparatus is situated in certain parts of the cerebral cor- 
tez, and we can conceive of an isolated affection of such parts, but it will 
be difficult to decide in how iax the sensory conducting paths immediately 
adjacent to these cortical centres are implicated in the diseases belonging 
to this category (cortical encephalitis, softening, hemorrhage, meningitis, 
poisoning, etc,). But this point possesses no special significance with re- 
gard to electro-therapeutics, so long as it can be determined that the affec- 
tion is situated in the brain or cerebral cortex. 

At all events, anaesthesias from inhibition of sensory conduction at any 
part of its course are much more frequent, and their pathogenesis much 
clearer. As in paralysis, this inhibition of conduction may be produced 
by various lesions, either in the peripheral paths of conduction, or within 
the spinal tracts, or finally by an affection of the paths of cerebral con- 
duction (hemorrhage, softening, tumors, sclerosis, etc). It is possible 
and indeed very probable that anaesthesia may be produced by so-called 
impalpable lesions of these various parts (for example, in hysteria, poison- 
ing, syphilis, etc.). 

The symptomatology of ansesthesias need be referred to merely to caU 
your attention to the fact that data with regard to the site of the lesion 
may be obtained from the distribution of the sensory disorder (confined 
to the territory of one or another nerve, in a paraplegic or hemi-paraplegic, 
or finally in a hemiplegic form), and that similar conclusions may be drawn 
from the more or less complete loss of sensation, from the character and 
distribution of the parsesthesiaB, and not less from the presence or absence 
of motor, vaso motor, trophic and special sense disturbances, neuralgia^ etc. 

Electrical examination can effect very Httle toward making a diagno. 
sis. I have mentioned previously that quantitative or qualitative changes 
in the electrical excitability of the nerve-trunks are unknown in anses- 
thesias. You will remember, on the other hand, that the electrical cur- 
rent may be employed in recognizing and defining the functional disorder 
of the sensory apparatus (Lecture X., page 93). 

Vigorous cutaneous irritants have always been employed as the chief 
means of treatment of an affection of the sensory nerves, which renders 
the integument and other tissues more or less insensible to stimuli. Elec- 
trical currents constitute the sovereign remedy against all forms of anaes- 
thesia, because they furnish the best and most convenient method of pro- 
ducing cutaneous irritation of any strength required, without causing any 
permanent change in the integimieni 

The objects of electro-therapeutics in ansesthesia can be defined in a 
few words, viz. : the removal of any affection which inhibits conducticm, 
exaltation of the excitability of the receptive organs, the removal of obsta- 
dies to sensory conduction itself and finally the removal of secondary 
nutritive disturbances which may be present and interfere with the con* 
duotibility of the sensory apparatus. 



SPECIAL ELECTRO-THERAPEUTICS. 276 

I may state in brief that these objects can be effected by the catalytic, 
▼aso-motor, modifying, and particularly the irritant actions of electrical 
onrrenta 

132. Personal observation. Anoestkesia in the distribution of the left tri» 
geminus nerve, — ^A woman, aged forty-eight years. Affected in August, 
1870, with formication of left side of face ; no pain, frequent vertigo ; re- 
cently formication in palate and tongue, diminution of taste upon left half 
of tongue ; patient otherwise healthy. 

December 13, 1870. — Diminished sensibility upon entire left half of 
face, tongue, and palate ; left eye reddened, super^cial ulcer of cornea. 
Taste diminished upon left anterior half of tongue. No disturbance of 
muscles of mastication. Distribution of facial nerve normal ; hearing 
normal. Galvanic treatment : 6 to 8 elements stabile, transversely through 
the temples and mastoid processes ; 8 elements Ca labile over entire side 
of face. After eighth sitting continued improvement, sensibility better, 
numb sensation in mouth lessened. After fifteenth sitting taste also im- 
proved. Patient then stopped treatment 

133. Personal observation. Traumatic paralysis and ancesthesia of the left 
ulnar and median nerves. — A man, aged twenty-one years. Had luxation 
of elbow in February, 1872, which was not reduced until sixteen days 
afterward. Middle of November, 1872, patient presents complete paral- 
ysis of ulnar and median distribution to the hand, with marked atrophy 
and complete De R Sensibility of hand extinguished in distribution of 
these nerve& At the elbow, eccentric sensations can be produced in the 
hand by the application of faradic current to median and ulnar nerves ; 
two inches above the wrist, eccentric sensations can no longer be pro- 
duced in this manner. Treatment : Ca labile and changes of polarity in 
median and ulnar nerves and their distribution. 

December 15th. — Sensibility present everywhere, though to a less 
extent than normal 

January 28, 1873. — Sensibility almost entirely restored ; motion un- 
changed. 

134. Observation by Moritz Meyer. Anaesthesia of the ulnar nerve. — A 
man, aged thirty-eight years. Contracted severe "sleep" paralysis of 
ulnar and middle cutaneous nerves six weeks ago. Complete anaesthesia 
of ulnar side of forearm and ulnar distribution of the hand ; paralysis and 
atrophy of muscles supplied by idnar. Faradic applications to eddn and 
muscles. Eetum of sensibility in five sittings; complete recovery in 
twelve sittings. 

135. Observation by Vulpian. Lesion of right cerebral hemisphere ; left 
hemiancesthesia, etc. — A man, aged forty-five years. Had an apoplectic attack 
two weeks ago ; followed by paresis of left side, loss of vision in left eye. 
The entire left half of the body is completely anaesthetic ; taste lost on left 
side, sight very much diminished on this side ; hearing normaL Anaes- 
thesia of left half of palate; loss of muscular sensibility on left side. 
Treatment: application of faradic brush to a circumscribed portion of 
integument on dorsal aspect of left forearm. Betum of sensibility of 
hand and anterior surface of thigh after three days. Slow progress of im- 
provement. In four weeks the extensor aspect of forearm has become 
sensitive, as also its inner surface and that of arm ; eccentric sensation 
returned upon stimulation of ulnar nerve in arm ; recovery almost complete. 



276 ELSGTBO-THEBAPEUnCS. 

136. ObBervation by OrasaeL Bight cerdmd hemiancBsihesia. — ^A male 
patient Presented complete history of right cerebral hemiansesthesia, 
with hemiparesis and diminution of taste and vision on right side. Tre- 
mor on volitional efifort in left upper limb. Treatment: strong foradic 
brash to external surface of right forearm ; no sensation at firsts but grad- 
ually increasing pricking feeling; from this time on, entire right side 
again sensitive, vision of right eye almost normal. Diminution of sensi- 
bility fifteen minutes later, but distinct improvement still present on fol- 
lowing day. Similar results from faradization of right and also of left Uiigh. 

137. Observation by Ldoir. Bight hynterical hemiancBsthesia, — A giri, 
aged thirteen and a hidf years. Had severe hystero-epilepsy at beginning 
of menstruation. Six months later, complete ansesthesia and analgesia of 
right half of body ; left ovarian hypersesthesia ; smell and taste markedlv, 
audition moderately, diminished on right side ; vision normaL A single 
application (four mmutes) of faradic brush to right forearm produced com- 
plete recovery of anaesthesia. Effect permanent 

In the selection of the method of electrical treatment of anaesthesia our 
main object is the removal of the lesion producing the loss of sensation, 
%,e., of any neuritis, compression, hemorrhage, myelitis, tabes, cerebral 
affection, etc., which may be present, not less of impalpable nutritive dis- 
turbances, if their exact situation can be determined, or of the general 
neuroses in which amesthesia is occasionally manifested. 

This part of the electrical treatment is the main factor in many cases, 
and, in itself, is often sufficient to relieve the anaesthesia. 

But the causal indication cannot always be met, partly because we are 
ignorant of the situation and character of the lesion, partly because it may 
be inaccessible to electrical treatment In not a few cases this alone 
proves insufficient; for example, regeneration may be so far advanced 
that conduction is indeed possible, but has not really occurred, and a 
vigorous impulse is needed in order to have it take place. Direct treat- 
ment then becomes necessary to relieve the anaesthesia or at least to pro- 
duce its rapid removal 

The direct treatment purposes an increase or restoration of the excit- 
ability of the peripheral (occasionally also the central) terminal apparatus, 
or a restoration of the conductibility of the centripetal paths of conduc- 
tion. The former possesses less importance, and usually coincides with 
the fulfilment of the causal indication ; the latter — the restoration of con- 
duction — is the main feature to be sought in the majority of cases. 

The methods of securing both objects are almost identical ; they con- 
sist, in the main, of a sufficiently vigorous, often repeated stimulation of 
the sensory terminal apparatus and paths of conduction, in order to re- 
move obstructions to sensory transmission by a vigorous process of ex- 
citation and thus force the restoration of conduction, and, finally, to make 
the path open for feebler stimulants, for the natural processes of excita- 
tion, by the frequent employment of these paths for artificial processes of 
excitation. 



8PE0IAL BLECTRO-THBRAPEUnOa 277 

In anaesthesia the irritation must be applied on the peripheral side of 
the lesion, and the peripheral terminal apparatus and paths of sensory 
conduction are always at our command for this purpose. The method for 
the direct treatment of anaesthesia, therefore, follows very simply, viz., 
peripheral irritation of the skin, of the sensory nerve-trunks, and, if neces- 
sary, of more deeply situated parts, if possible, with such a great strength 
of the current that a sensation, however feeble it may be, is produced. 
If this is not effected at once, it may be at a later period, inasmuch as the 
repeated impaction of the waves of excitation against the obstruction may 
gradually remove the latter, and render the path free for strong stimuli, 
and gradually for weaker ones. 

In employing the galvanic current, the Ca should be applied stabile 
and labile to the integument and nerve-trunks ; also cathodal closures 
and changes of polarity to secure more vigorous excitation. A very intense 
irritation is produced by the metallic brush armed vnth the Ca, but very 
strong currents are required, and care should be taken that the brush be 
not kept too long in one place, since blisters are produced very rapidly in 
this manner. 

For this purpose, however, the faradic current is usually employed with 
the brush or moxa and vigorous, rapidly interrupted secondary currents. 
The chief method, then, is the application of the farado-cutaneous brush, 
the skin having been dried by the addition of a powder. Furthermore, 
the nerve-trunks themselves may be stimulated vrith moist electrodes, or 
applications made to the joints, muscles, mucous membranes, and deeper 
parts. At the onset, the current should be so strong that a slight sensa- 
tion is produced ; this usually increases with rapidity, so that, as improve- 
ment progresses, weaker currents will be sufficient 

In this treatment of anaesthesia, however, the surprising fact has been 
discovered that not alone the directly irritated ports of the skin and the 
nerve-trunks may recover their sensibility, but that adjacent or even re- 
mote portions of the integument are relieved temporarily or permanently, 
and that anaesthesia of the mucous membranes and joints, even of the 
special senses, is relieved by simple local faradization of a circumscribed 
portion of the integument This is especially true of cerebral anaesthesias 
(produced either by organic lesioDS or by impalpable changes) and not 
less of other forms, mainly hysterical hemianaesthesias, in which the ap- 
plication of the brush to a small part of the skin will often restore the 
sensibility in toto. Special attention has been called recently to this fact 
by Vulpian. He found that the daily application of the faradic brush 
with very strong currents for eight to tea minutes to a small part of the 
skin of the upper limb (external surface of the forearm) had this favorable 
effect^ and was often more successful than faradization of the entire anaes- 
thetic region. Grasset has shown that this effect may be produced by ap- 
plications to other parts of the anaesthetic skin, and even to the healthy 



278 ELEOTBCKrHEBAPBUnCS. 

side of the body. These facts are probably related to the metalloscopic 
phenomena of hysterical hemiansesthesia, but their explanation is involTed 
in obscurity. 

In some cases, finally, we may be called upon to relieve the eecondaiy 
trophic disturbances in the sensory nerves, either finer nutritive disorders^ 
such as are caused by inaction, or degenerative atrophy from separation 
from the trophic centres. The trophic centres of the peripheral sensory 
tracts are situated in the spinal gaoglia; this indication is mainly pre- 
sented, therefore, in peripheral ansesthesia, and may be met in the same 
manner as in paralysis {vide page 192). Secondary degenerations also oc- 
cur in spinal ansesthesia ; the trophic centres for a part of the conducting 
paths in question also appear to be situated in the spinal ganglia. It is 
questionable whether electrical treatment is advisable in spinal anaesthesia. 

The results of the treatment of ansBsthesia vary extremely, and are in- 
fluenced considerably by the nature of the primary disease. An entire 
series of cases, accordingly, is incurable. Great difierences are also mani- 
fested among the curable cases; in some recovery occurs within a few 
minutes or after a small number of sittings, or improvement occurs forth- 
with, but is only temporary, and recovery occurs very gradually. This is 
especially true of the various hysterical anaesthesisB, of rheumatic, mild 
compression ansBsthesisB, etc In other cases improvement occurs very 
slowly, as in traumatic paralyses, neuritis, tabes, and other aflbctioiis of 
the spinal cord. 



Concerning the individual forms of ansosthesia I have very little to 
add. 

AnsBsthesia of the trigeminus is one of the most impprtant varieties, 
and requires careful treatment: the galvanic current to the trunk and 
branches of the trigeminus, Ca labile or the faradic brush to the integu- 
ment of the face and the mucous membrane of the mouth and tongue. 
The electrical ciurent also appears to possess a favorable effect upon the 
associated hypersemia of the conjunctiva. 

AmBsthesia of the pharynx and the entrance to the larynx occurs vexy 
often after diphtheria, and requires especial attention on account of the 
great danger of " food pneumonia : " ' intrapharyngeal and percutaneous 
application of faradic or galvanic currents is indicated, especially upon 
the region of the superior laryngeal nerve. Jurasz recommends the alter- 
nate use of both currents. 

In vasomotor ansesthesia it is necessary to treat the vasomotor nerfes 
by methods which will dilate the vessels {vide the next Lecture), and also 



' Paeamonia due to the entimnoe of partidea of food into the langB. 



SPECIAL ELEOTBO-THERAPSUnOS. 279 

to make very irritating applications to the ansBsthetic integument (An sta- 
bile, Ca labile, faradio brush) ; this form usuallj yields rapidly to treat- 
ment 

In hysterieal anaesthesia and hemianaesthesia, in addition to treatment 
of the central organs, cutaneous faradization should not be neglected ; 
ovarian hyperaesthesia or tender spinal points, which may be present, 
should also be treated. Yulpian's method may be tried. 

In ataxic anaesthesia and analgesia, treatment of the spinal cord itself 
is mainly indicated and often proves successful. Very favorable results 
have also been obtained by the peripheral application of the faradic brush. 



VIII. DISEASES OF THE CERVICAL SYMPA- 
THETIC— VASOMOTOR, TROPHIC, AND AL- 
LIED NEUROSES. 



LECTURE XXIX. 

Diaaaiei of the Gemoal Sympathetio ; Oocuxrenoe and SjmptomB; Irritatian and 
Paralysia; Methods of Electrioal Treatment — ^Vasomotor Neoxoaes — Cataneoiu 
Angioneorosea— Symptoms of Spasm and Paralysis of the Vasomotor Kearoaes ; 
Methods of Electrical Treatment-— Intermittent Dropsy of the Joints— Vasomotor 
Trophic Neuroses of the Integument — Anomalies of the Secretion of Perspim- 
tion— Progresadve Facial Hemiatrophy ; Probable Site ; Methods of Bleoliici^ 
Treatment— Soleroderma ; Method of Treatment. 

In giving a short description of the electro-thera{)eutic8 of diseases of 
the cervical sympathetic, I shaU refer alone to those diseases of this tract 
or its immediate origin in the cervical spinal cord, whose existence has 
been firmly established to a certain extent. I am by no means of the 
opinion that migraine, Basedow's disease, progressive facial hemiatrophy, 
or even progressive muscular atrophy, may be included with any degree of 
probability in this category. 

The cervical sympathetic reacts to morbific influences like eveiy other 
peripheral nerve, and its diseases are included, therefore, under the same 
therapeutic standpoints as the lesions of other nerves. Such affections are 
of rare occurrence, and isolated lesions of the sympathetic, indeed, consti- 
tute pathological curiosities. But they present such a peculiar and char- 
acteristic symptomatology, and they possess so great a significance on 
account of the numerous relations of the sympathetic to all possible 
parts of the central nervous system, the organs of special sense and cer- 
tain vegetative organs, that their separate consideration appears justifia- 
ble, however skeptical we may be with regard to the mysterious relations 
of the cervical sympathetic to other neuroses. 

Diseases of the sympathetic may be produced by inflammation, rheum- 
atic influences, trauma, compression, etc., by diseases of the cervical 
cord and medulla oblongata, and occasionally also by impalpable lesions 
(hysteria, neurasthenia). These affections appear, in general, under two 
forms, either as irritation or paralysis of the sympathetic ; but both con- 
ditions may coexist, irritation being predominant in one portion of the 



SPECIAL ELEOTBO-THERAPEUnOS. 281 

fibres and paralysis in another, or they may follow one another. The re- 
sultant symptomatology is sufficiently characteristic, but usually requires 
very careful examination, since the oculo pupillary as well as the vasomotor 
symptoms are often not well marked. 

The symptoms of irritation of the sympathetic consist of pallor and 
coolness of the corresponding ^de of the &ce and head, hardness and tens- 
ion of the temporal arteries, dilatation of the pupils (with diminished re- 
action to light or power of accommodation), moderate protrusion of the 
eyeball and alight dilatation of the palpebral fissure, diminution of perspi- 
ration, etc. 

The symptoms of paralysis of the sympathetic consist of increased 
temperature and redness of the side of the isLce, head, and neck, a feeling 
of heat and parsesthesia, dilatation and increased pulsation of the arte- 
ries, congestion of the conjunctiva, headache, vertigo ; furthermore, con- 
traction of the pupil with retained reaction to light and power of accom- 
modation, narrowing of the palpebral fissure, slight retraction of the 
globe, increased secretion of tears and perspiration, etc. 

Electrical examination will not aid the diagnosis, since irritation of 
the sjrmpathetic can not be effected with certainty, but the application of 
the electrical current in such cases occasionally will influence the morbid 
disturbance forthwith and thus afford aid in the choice of the therapeutic 
procedure& . 

138. ObservcUion by Otto. Paralyna of the cervical sympathetic. — Mrs. 

E , never very sick, was suddenly affected in the spring of 1870 with 

vomiting, headache and vertigo ; diminution of vision. Disappearance of 
symptoms in two weeks, but marked redness was then noticed in left half 
of face and neck ; later, difficulty of speech, impairment of memory ; oc- 
casional feeling of burning heat in head, with vertigo and increased red- 
ness of the parts mentioned ; attacks increased on excitement Absolute 
insomnia, depression and constant excitement ; profuse perspiration fre- 
quently appears on reddened parts. Condition remained almost un- 
changed at end of one and one half years ; cervical sympathetic not ten- 
der on pressure. 

Gkdvanization of sympathetic with Ca ; after application of three tnin- 
utes, patient almost free from vertigo, and slept uninterruptedly the fol- 
lowing night. After ten sittings, patient almost free from vertigo ; the 
eiythema, which had grown pale during the passage of the current in the 
fint few sittings, disappeared almost entirely ; sight and speech better, 
disposition more cheerful. Cured {)ermanently ^fter eighteen daily sittings. 

The electrical treatment is similar, on the whole, to that of lesions of 
the peripheral nerves ; if the lesion is situated in the cervical sympathetic 
itself, it should be treated according to general principles ; if it may be 
assumed that the affection is located in the cervical cord, this should be 
treated in the well-known manner. 

When such treatment is impossible, the method of application depends 



282 BLECTBO-THEBAPEUTIOS. 

upon the character of the main symptoms, especially of the YBaomaUsr 
disturbances, as I shall explain in detail at a later {)eriod. I will merely 
mention at this time that the symptoms of irritation of the sympathetic 
should be treated exclusively by the galvanic current, preferably by tite 
stabile application of the anode. A ** medium " or an elongated electrode 
is applied to the sympathetic or its chief g^glia (Ca upon the spine or in 
an indi£ferent position) and quite a strong current passed stabile ic^ a 
few minutes, until an effect upon the vessels or the pupil is noticed. 

In distinct paralysis of the sympathetic a mild and short application 
of the Ca is indicated with a feeble current^ frequent iuterruptions, and 
repeated cathodal closures, perhaps also some changes of polarity. Yeiy 
short sittings (one to two minutes) should be had, since otherwise the 
opposite effect may be produced. Moderate faradization of the neiree 
may also be tried. 

It will be useful, as a general thing, to combine this with similar treai- 
ment of the centres in the cervical cord, in the one case the stabile appli- 
cation of the An, in the other a moderate stabile, perhaps also labile 
application of the Ca. 

In some cases peripheral treatment may also be added as an auziUaiy, 
the integument of the face and its vessels being . treated with the An or 
Ca stabile or labile, or with the f aradic brush, the latter being emplojed 
to produce reflex relaxation and redness of the skin in .spasm of the 
vessels. 



Vasomotor disorders occur with extreme frequenqr. Tou are aware 
that peripheral nervous affections (neuralgias, ansesthesias, paralyses), as 
well as spinal cerebral diseases, are often accompanied by such disturb- 
ances, but then, as a rule, they require no special treatment But such 
disturbances occur occasionally in a more inde{)endent manner — affections 
in which irritative or paralytic conditions of the vasomotor nerves and 
corresponding changes in the calibre of the vessels and in the circulation 
constitute the primary and essential feature, which may in turn give rise 
to a number of effects upon sensation, motion, action of the heart, cerebral 
function etc. These are known as vasomotor neuroses. They play per- 
haps a much more important part in the pathology of many internal 
organs than we now imagine, but those which are more accurately known 
are merely the vasomotor neuroses in the tegumentary and, at the most, 
the deeper distribution of the cervical sympathetic, while we know very 
little concerning the vasomotor neuroses of the internal organ& 

The cutaneous angioneuroses will engage our attention for a momeni 
They appear merely in two forms but of very variable localization, some- 
times more diffuse, sometimes sharply localized in certain nerve-traots. 
The limbs, especially the upper ones, are the most frequent site of these 



SPECIAL SLEOTBCKTHSBAPEUnOS. 283 

neuroses, then the face and neck, Le,, those parts which present normally 
the greatest Tariation in the Tasomotor phenomena. 

Spasm of the vasomotors (cutaneous angiospasm) is manifested by con- 
traction of the vessels, pallor and coolness of the skin, which sometimes 
looks as white as chalk and cadaverous, especially la the fingers, or as- 
sumes a more livid, cynanotic coloration after prolonged continuance of 
the spasm ; this is usually associated with spasm of the small muscles of 
the skin (cutis anserina) and the sequeke consist of formication, pain, 
diminished sensibility, awkwardness in executing delicate movements, etc., 
advancing to changed action of the heart and even vasomotor angina 
pectoris, if the disorder is wide-spread. The condition is usually 
paroxysmal, and is increased by cold, etc The very rare condition known 
as liver angioneuroticus ('^ essential cyanosis ") may be regarded, perhaps 
as the analogue of the former ; it is characterized by a flecked, dark bluish 
red congestion, with dull pain, objective coldness, sometimes associated 
with haematuria, and occurring in paroxysms probably due to temporaxy 
spasm of the small veins of the skin. 

PandysiB of the vasomotors (cutaneous angioparalysis) appears in the 
form of intermittent or permanent flecked or diffuse redness ("essential 
redness **) and increased tem{)erature of the skill, with increased pulsation, 
parsBsthesisB, perhaps also vidth headache, vertigo, sleeplessness, irritable 
action of the heart, increased production of perspiration, etc. In indi- 
vidual cases this affection, especially in the hands and feet, has been found 
associated with severe pains and hypersesthesia. 

These cutaneous angioneuroses occur mainly in nervous, hysterical, 
neurasthenic individuals and may be produced by all possible morbific in- 
fluences (cold, manipulations in water or acrid fluids, certain poisons, etc.). 

The interpretation of these various disturbances is impossible in the 
present state of our knowledge and in the unsettled condition of the 
question concerning the existence and distribution of the vasodilator and 
vasoconstrictor, inhibitory and irritant vasomotor paths and centres in 
the spinal cord, and in view of the possibility that they maybe stimulated 
in a direct as well as reflex manner. 

The previously reported case of Otto (Observation 13) is an excellent 
illustration of vasomotor paralysis ; the following history will serve as an 
example of vasomotor spasm : 

189. Observaiumby NothnageL Vasomotor neurtms of the upper limbs, — k, 
woman, aged forty-nine years. Six years ago, feeling of formication in both 
hands and shooting pains extending to the arms, improvement after the 
lapse of six months ; occasional complaint since then. Violent exacer- 
bation during past three months. Status : complains of a dead feeling, 
formication and severe pains in both hands and forearms of variable in- 
tensity ; improved by warmth and work, rendered worse by cold and rest ; 
very bad at night. Sensibility slightly dulled ; all ^rmptoms somewhat 



^ 



284 ELSCTBO-THERAPSUTICS. 

more marked on left side; do tenderness on pressure. Farado-cnta- 
neous brush for a long time with little effect After a long intermimriofn, 
galvanic treatment three times a week (An upon the plexus, Ca on the 
neck, stabile currents for three to five minutes). Left extremity entirelj 
relieved in three weeks, right limb much improved ; gradual recovery. 

It would be premature, in the present state of our physiological 
knowledge, to decide with any degree of certainty upon the methods ci 
electrical treatment of the vasomotor neuroses. We are forced to 
determine the most useful method empirically, by the therapeutical 
experiment 

A starting-point is furnished us by the scanty electro-physiological 
data, to which I have referred previously (Lecture VL), viz., that mod- 
erate f aradic stimulation mainly contracts the vessels, severe &uradic irrita- 
tion, especially the brush, leads to secondary dilatation ; the galvanic cur- 
rent first causes contraction, then dilatation, the latter occurring so mndi 
more rapidly the stronger the current ; cathodal closures contract the Tea- 
sels, anodal duration dilates them vndely ; finally, ascending or descend- 
ing stabile galvanic currents in some nerves cause the vessels to dilate. 

In vasomotor spasm, therefore, the stabile application of the An upon 
the vasomotor nerves and centres (and also upon the vessels themselTes) 
is chiefly to be recommended. Nothnagel applied, vdth very good re- 
sults, the An upon the brachial plexus, the Ca in the neck, stabile, for 
three to five minutes. Strong stabile currents in different directions may 
also be passed, for quite a long time, through the affected nerves ; dila- 
tation of the vessels may also be obtained by vigorous faradization of the 
nerve trunks and by the application of the faradic brush to the skin. In 
obstinate cases these various methods may be tried in succession. 

In vasomotor paralysis the opposite methods of treatment are advisa- 
ble : the stabile application of the Ca to the affected nerves and centres, 
with a feeble current and repeated interruptions ; a few changes of 
polarity, vdth a not too strong current of short duration, may also be 
made. Also, a mild labile application of the Ca to the nerves and skin, 
with very feeble currents ; likevdse feeble faradization of the nerves and 
integument with moist electrodes, or a brief and not very strong applica- 
tion of the faradic brush. It is advisable in such cases, perhaps, to apply 
the wire brush to remote nerve trunks and parts of the skin, preferably 
upon symmetrical parts of the body. But it has not been determined as 
yet what the localization and strength of the stimulus should be in order 
to produce reflex contraction or dilatation in a definite vascular territory. 
According to Rumpfs experiments it seems that feeble and moderate 
faradization is most serviceable in producing contraction upon the non- 
irritated side of the body (after previous dilatation), while very strong 
currents produce marked permanent dilatation, after previous contraction, 
upon the non-irritated side. 



SPECIAL ELSOTBOTHSBAPEUnO& 285 

But all theee methods need to be tested practioally in cases of disease 
in which entirely diffiorent phenomena are often presented from those 
which we are led to expect from physiological experiments. Not until 
such therapeutic experiments ha^e been made in a series of cases wiU we 
be able to reach a more positive conclusion with regard to the results of 
electro-therai)eutics in yasomotor neurosea For the present^ however, it 
may be said that the results are satisfactory, on the whole, and often fol- 
low very rapidly^ especially in milder cases of such neurose& 



There are various reasons for including among the vasomotor neuroses 
the equally rare and peculiar, periodically recurring joint affection, known 
as hydrops articulorum intermittens. This view of the affection naturally 
implies an attempt at electrical treatment This was done unsuccessfully 
by Seeligmueller ; but Pierson states that he had favorable results in one 
case from galvanization of the neck. If such a case comes under your 
care, I should advise, during the attack itself, the method of treatment 
recommended on the preceding page for vasomotor paralysis, the applica- 
tions being made to the knee itself, to the corresponding nerve-trunks, 
and the spinal cord, perhaps also to the other leg or to the sole of the 
foot on the same side (mainly feeble currents). During the intervals, 
treatment of the lumbar cord, the crural and sciatic nerves, with the gal- 
vanic current, appears to me to be indicated. 



Various diseases have also been included recently among the vaso- 
motor-trophic netux>8es, or at least have been brought in relation with 
anomalies of the nervous system. Among these affections I will merely 
mention the various forms of erythema, urticaria, and especially herpes 
zoster. These processes are, indeed, of very littie interest to the electro- 
therapeutist at the present time, but they offer a very fine field for electro- 
therapeutic experiments. The neurotic character of the affection is least 
doubtful in herpes zoster ; this may occur independentiy or be associated 
with neuralgia in the same locality. It appears to depend upon inflam- 
matory processes (neuritis), either in the peripheral nerves or more fre- 
quentiy in the spinal ganglia or in the Gasserian ganglion. In appropri- 
ate cases, therefore, the treatment suitable to neuritis (vide Lecture XX.) 
should be resorted to. As a rule, this will be unnecessary, at least in 
herpes zoster, since the disease usually recovers spontaneously in a few 
daya At all events, the presence of zoster is always an indication that 
the neuralgia which may be present depends upon neuritis and that the 



386 ELEOTBO-THBBAPEUnOS. 

treatment should be directed specially to the region of the spinal gang^ 
or the Gassenan ganglion. The circumscribed anaesthesiffi of the skia 
which are sometimes left over after severe herpes zoster are treated in 
exactly the same manner as other ansesthesisd. 



Among the vasomotor neuroses were included formerly the anomalies 
in the secretion of sweat, which sometimes attain a certain independence, 
may present remarkable forms and localizations, and, in &ct, are combined 
not infrequently with the vasomotor neuroses. At the present time, how- 
ever, we know that the secretion of sweat is presided over by its own 
nerves and cerebro-spinal centres, and that these neuroses may thus pre- 
sent a certain independence. When, as occurs in certain vasomotor neu- 
roses (angioparalysis), an increased secretion of perspiration is regulaiiy 
found, this may be explained by the increased supply of blood and the 
rise of temperature, which stimulate the sweat-glands, but is probably not 
due to paralysis of the inhibitory nerves of the secretion of perspiration. 
However, these neuroses may be entirely indei)endent of vasomotor dis- 
turbances. 

They appear in the form of hyx>eridrosis (increased secretion of sweat) 
iind anidrosis (diminished secretion of sweat), either more or less diffused 
or locally circumscribed, especially frequent upon one half of the face and 
with or without vasomotor disturbances or symptoms of an affection of the 
sympathetic. 

Little is known with regard to their electrical treatment If the anom- 
alies of the secretion of sweat are merely the result of a vasomotor or 
sympathetic neurosis, and of the changes in the circulation induced 
thereby, these disturbances must be treated in an appropriate manner. 
If the affection is independent, it must be treated like the vaso-motor 
neurosis, a stimulating method being employed in anidrosis, the reverse 
in hyperidrosis. 



I will call attention at this place to an affection which, perhaps more 
than all others, merits the appellation of a tropho-neurosis, viz., progr^- 
4dve facial hemiatrophy. 

This chronic progressive atrophy of one half of the face, extending to 
the soft parts, the integument, and bones, and finaUy leading to very great 
deformity of the fsuce, is evidently neurotic in its origin, although nothing 
positive has been determined with regard to its real nature and the local- 
ization of the process. 

I am inclined to the opinion that this disease is an affection of the 
trigeminus nerve ; the view that it is situated in the cervical sympathetic 
appears to me much less plausible. It is entirely uncertain whether the 



SPECIAL BLECTBO-THBRAPEUTICS. 287 

lesion is situated in the Gasserian ganglion, or in more central paths or 
in a trophic centre which is connected with the origin of the trigeminus. 

Experience teaches that this affection is incurable after it has been 
fairly established. It is only in the very beginning of the disease, there- 
fore, that there is any chance of producing good results from treatment. 

As the most suitable method of treatment I should recommend the 
following: galvanization of the trigeminus, especially the region of the 
Gbsserian ganglion (transversely through the middle temporal region) ; 
then galvanization of the medulla oblongata (transversely through the 
mastoid processes) and the cervical cord, in order to influence the nuclei 
of origin of the trigeminus ; likewise galvanization of the cervical sympa- 
thetic, in order to stimulate the trophic processes by increasing the flow 
of blood ; finally, direct treatment of the face with stabile and labile cath- 
odal applications in order to produce the same effect. 



Finally, I may be permitted to say a few words with regard to so-called 
scleroderma, a very peculiar affection of the skin and the subjacent soft 
parts, which is more and more regarded as trophic and vasomotor in its 
origin. The vasomotor disorders which not infrequently precede the 
disease, the processes which run their course with symptoms of an atro- 
phic inflammation of the skin, the atrophy, tension, and glossy appearance 
of the skin, the shrinking of the subcutaneous cellular tissue, the atrophy 
of the musdes, abnormal pigmentation, anomalies in the growth of the 
hair and nails, the symmetrical development and progressive character of 
the disease, all favor its nervous origin, though this is by no means posi- 
tively proven. Perhaps the affection is located in the spinal cord and its 
trophic centres, perhaps also in the sympathetic and its ganglia. 

Many trials of electrical treatment have been made in this disease, and 
I have treated an entire series of cases with very little success. Becently, 
however, I have secured an undoubted improvement by galvanic applica- 
tions (combined with arsenic and inunctions of fat) in a case which had 
lasted six to seven years. 

The following was the method employed : galvanization of the cervical 
and lumbar enlargements of the cord with stabile currents and change of 
polarity ; then galvanization of the cervical sympathetic in the ordinary 
manner ; finally, peripheral labile (Ca) galvanization of the skin in aU the 
parts affected (back, neck, chest, upper limbs, especially the hands) with 
sufficiently strong currents to produce redness of the skin. The result 
was not merely subjective, but also very evident objectively, although, as a 
matter of course, there was no question of recovery. 

Fieber has successfully treated, by a similar method, a case in which 
the disease was confined to the left upper limb. 



V, 



rX. GENERAL NEUROSES.— CENTRAL AND 
OTHER FUNCTIONAL NEUROSES. 



LECTUBE yyy 

Th^arj of the Fanotional Neuroses — Eleotro-therapentio Objects: BemoTAl of the LooaI 
Nntritiye Disturbances ; Influence upon the Entire Nerroos Sjstem and the Bn- 
iire Organism ; fiemoval of Definite Causes of Disease ; Treatment of Individual 
Symptoms — 1. Neurasthenia: Various Forms; Nature of the Disease; Methods 
of Treatment ; Results— 2. Hypochondriasis — 8. Hysteria ; its Nature, Object, 
and Methods of Electrical Treatment~4. Epilepsy — 5. Co-ordinate Professiooal 
Hyperkineses ; Writer's Spasm ; Various Forms ; Methods of Treatment — 6. 
Chorea Magna. 

Of the diseases of the nervous sjstem in the strictest sense it now re- 
mains to discuss a large group of frequent, severe, and important afiGdc- 
tions. These morbid processes vary greatly in character, but a feature 
common to all is that they must be regarded as so-called " functional neu- 
roses," i.e,, diseases in which a gross anatomical lesion is not demonstra- 
ble by our present means of investigation. Not even the exact localization 
of these affections in the nervous system — whether in the peripheral nerves, 
spinal cord, brain or sympathetic system— is always known, or several 
localizations must be assumed at the same time ; indeed, in certain forms 
of these neuroses, a general, diffuse affection of the entire nervous i^ystem 
is assumed, and they are called " general neuroses." 

We are apt to believe that purely functional, molecular and finer nutri- 
tive disturbances will be relieved more readily than grosser anatomical 
lesions by the action of electricity. Nevertheless, the electrical treatment 
of these functional neuroses is only in the first stages of its development 

The causes of this circumstance are manifold ; in the first place, our 
ignorance of the situation and character of the affection, which always 
antagonizes therapeutic trials ; then the dread of a bad effect upon forms 
of disease which are in themselves dangerous, and are associated with 
irritative symptoms, and in which we fear the appHcation of a new " irri- 
tant ; " furthermore, the great sensitiveness of the patient to all thera{)ea- 
tic measures, and so also to the electrical current, which, when applied 
incautiously, produces unfavorable symptoms ; and finally the many failures 



SPECIAL BLECTRO-THSBAPEUnOS. 389 

of electrical treatment in these neuroses, and which, though they may be 
explained in part by an improper choice of the method of applicatkni, 
none the less deter from further attempta 

However, it appears to me to be urgently indicated not to give up 
these attempts entirely, but to renew them again, modified and im- 
proved by our daily progress in the knowledge of these obscure and re- 
markable diseases. And I shall, therefore, not omit their consideration, 
although their electrical treatment hitherto has not possessed much prac- 
tical significance. 

The first object, especially in those functional neuroses which can be 
localized with some degree of certainty, is the removal of the local nutri- 
.tive (functional) disturbance. The catalytic and alterative actions of elec- 
trical currents must be relied upon for this purpose, and they may be 
secured by various methods (stabile galvanization or faradization, central 
galvanization, application of feeble, continuous currents) ; or this purpose 
may be sought for in an indirect manner by influencing the circulation of 
the diseased parts, and by indirect catalysis (galvanization of the sympa- 
thetic and the cervical cord, reflex action from the skin, etc.). As a 
matter of course, such applications may be variously modified in individual 
casea 

In the second place, a stimulant^ modifying, alterative influence upcm 
the entire nervous system, or even the entire organism, may be employed 
as a curative measure. The former, in the so-called general neuroses^ 
which involve the greatest part of the nervous system at the same time ; 
the latter partly in the same direction, partly in order to exert a favorable 
influence upon the nervous system by improving the general nutrition and 
stimulating the entire organism. For these objects we should resort 
especially to the methods of general faradization, general and central gal- 
vanization and the electrical bath. 

It may also be our object to effect the removal of definite causes of 
disease in so far as they are accessible to the electrical current, and in so 
much as they produce the disease or give rise to individual attacks. In 
this category belong, for example, the relief of peripheral neuralgias, so 
tax as they affect the development of epilepsy, chorea, tetany, etc., the 
treatment of an aura which regularly precedes an epileptic attack, the re- 
lief of ovarian hyx>eraBsthesia in severe forms of hysteria, the relief of 
spermatorrhoea, etc., as causes of spinal neurasthenia, the treatment of 
painful points in writer's spasm, chorea, hysteria, etc. — all these objects 
must be effected according to the previously mentioned rules and methods. 

FinaUy, a very wide field of activity remains in combating individual 
prominent symptoms of the functional neuroses, such as convulsions, par- 
alyses, neuralgias, hypersBsthesisd, ansesthesise, migraine, vasomotor and 
trophic disorders, impotence and spermatorrhcea, asthenopia and photo- 

phobia^ conditions of fear and insomnia. In certain forms of disease which 
19 



290 ELECTRO-THERAPEUTICS. 

present but one or a few symptoms, and whose pathogenesis and localiza- 
tion are perhaps obscure, this very object may occupy the foreground to 
such an extent as to constitute the main feature in treatment But in 
almost all these cases it is well to pay special attention to the methods of 
central treatment 

Let us now see what can be done by such means in the indiyidual 
forms of the functional neuroses. 

I begin with the most frequent, and perhaps the most important, of 
these affections, viz. : 

1. Neurasthenia or nervous exhaustion, — This is the feshionable neuro- 
sis of the present time, and appears in a thousand remarkable forms. It 
may be best described as a marked degree of irritable weakness of the 
nervous system, accompanied by the most varied functional disturbances, 
although we are not justified in assuming an anatomical foundation. 

This is not the place to enter into the symptomatology of this affec- 
tion. In making the diagnosis, however, you should always remember 
that, despite the innumerable complaints of the patient, the most careful 
examination always affords an absolutely negative result (with the excep- 
tion, perhaps, of some spinal tenderness on pressure, a slight increase of 
the reflexes, coldness of the hands and feet). Every objective change, 
however slight, of sensation, motion, the reflexes, pupils, etc., must cast a 
doubt upon the accuracy of the diagnosis. Electrical examination offers 
no assistance, since it reveals, as a rule, absolutely normal oonditiona 

With regard to treatment, it is advisable to differentiate various forms 
of the disease : one in which the cerebral functions are mainly affected 
(cerebral neurasthenia), and which is especially characterized by a sense 
of pressure in the head, inability to work, sleeplessness, psychical depres- 
sion, pathological sensations of terror (" fear of places," dread of light- 
ning, shooting, human beings, diseases, etc.), palpitation of the heart, 
etc. ; another which affects mainly the spinal functions (spinal neuras- 
thenia and spinal irritation), and in which weakness and a feeling of ex- 
haustion, pain in the back, tremor, parsesthesise and pains in the limbs, 
disturbed sexual function, vasomotor disorders and the like occupy the 
foreground ; and, Anally, a not infrequent combination of both, in which 
the disturbances are diffused more or less over the entire cerebro-spinal 
system (general neurasthenia) and may occur in the most manifold com- 
binations. 

All considerations concerning the character of this widespread neuro- 
sis lead to the exclusion, as causes of the disease, of circulatory disturb- 
ances (hypenemia or ansemia) of the nervous system as well as of grosser 
anatomical changea In the majority of cases the circulatory changes are 
not the causes but the results of the disease, and are merely the expres- 
sion of the neurasthenic affection of the vaso-motor apparatus itseU. 
However, this may be the primary feature occasionally (vaso-motor near 



SPECIAL ELECTRO-THERAPEUTICS. 291 

asthenia), atid then cause further disturbances by leading to abnormal 
distribution of blood in the central nervous system. In the large major- 
ity of cases, however, we must assume a finer nutritive disturbance of the 
implicated nervous apparatus, the real nature of which is entirely un- 
known, and for whose functional expression the conception "irritable 
weakness " is the most appropriate. 

In addition to other remedies, electricity often produces admirable re- 
sults in the treatment of this neurosis. Its office consists in the removal 
of the nutritive disorder of the nervous system, in the strengthening of 
the entire organism, and in combating individual and especially annoy- 
ing symptoms. The galvanic as well as the faradic current may be em- 
ployed for this purpose. In the cerebral form, the galvanic current is 
used in galvanization of the head, sympathetic and cervical cord in the 
manner which I described in detail under the head of electro-therapeutics 
of the brain ; in the spinal form, galvanization of the spine and the sym- 
pathetic, perhaps also of the legs, is performed in the manner previously 
described (I prefer the descending current). In general neurasthenia, 
both forms of application or central galvanization may be resorted to. 

The faradic current may be employed with the same methods of appli- 
cation, but I would recommend specially general faradization as a very 
valuable method in such cases. If the affection is characterized by very 
marked vasomotor disturbances and symptoms of congestion of the brain 
and spinal cord, you should not fail to employ the treatment with the 
faradic brush recommended by Bumpf (application of the brush to large 
portions of the integument of the trunk and extremities). 

A long series of symptomatic indications may also be presented. 
Headache, migraine, pains in the back are treated according to the direc- 
tions laid down in the discussion of neuralgia (Lectures XXV. and 
XXYL). Galvanization or faradization from the neck to the epigastriiun 
and the prsecordial region, and galvanization of the sympathetic and 
pneumogastric are not infrequently useful in feelings of terror attended 
with palpitation of the heart, etc. In insomnia, the methods previously 
mentioned (Lecture XYI.) may be employed. Weakness and pain in the 
legs are not infrequently ameliorated by direct faradic or galvanic appli- 
cations. Sexual weakness, premature ejaculation, impotence, etc., may 
be treated by the methods which will be described at a later period (Lec- 
ture XXXVL) ; faradization of the rectum is often useful in constipation 
(vide Lecture XXXV.). 

Ghreat caution should be exercised in the employment of any of these 
methods. We have to deal with extremely irritable and sensitive individ- 
uals, and very feeble cuirents and short applications, therefore, should 
always be resorted to at the onset ; every patient should be tested, at the 
beginning of treatment, with regard to his '* electrical sensitiveness." 

The restdts of electrical treatment in neurasthenia are by no means 



292 BLEOTBO-THESAFSXJTICS. 

always prompt and brilliant Very satisfactory and rapid results will be 
achieved in some cases, especially in the milder forms with a slight neu- 
ropathic taint In many cases, prolonged and patient treatment will pave 
the way merely for gradual improvement, and not infrequently time and 
labor will be wasted upon patients whose disease resists the most jodi* 
cious and varied treatment 

2. Hypochondriasis presents intimate relations to neurasthenia and also 
leads gradually into the domain of the psychoses. It maybe described as 
a form of mournful depression, in which the attention of the patient is 
concentrated chiefly uppn morbid conditions of his own person and their 
possible evil results (pathophobia). It is developed usually upon the 
foundation of a neuropathic anomaly of constitution, is associated very 
often with disturbances of the digestive organs and the sexual apparatus 
and in addition presents numerous nervous disorders, such as abnormal 
sensations, insomnia, sensations of terror, apathy, constipation^ etc. Ju 
these cases, also, the objective appearances do not correspond in any re- 
spect to the intensity of the subjective complaints. 

In this neurosis electricity is resorted to vrith relative infrequency and 
perhaps more rarely than it deservea The same methods may be em- 
ployed as in neurasthenia, especially general faradization. A very favor- 
able effect is produced not infrequently by the treatment of prominent 
symptoms of the disease, such as constipation, impotence, insomnia* eto.» 
by the methods described above. 

In addition, all these patients should imdergo careful psychical treat- 
ment and the electro-therapeutic procedures should also be utilized for 
this purpose. I would also remind you to be careful in the selection of 
the strength of the current^ since many of these patients are very sensitive. 

8. Hyateria, this remarkable functional neurosis, with its innumerable 
symptoms and its variable course, is a frequent object of electrotherapeu- 
tics, despite numerous and often surprising ftdlures. On the whole, hys* 
teria resists electrical treatment as obstinately as it does all other mea»- 
ure& This must be attributed in part to psychical causes, in part to the 
often enormous irritability of the patient 

The nature of the affection is still very obscure and vire are forced to 
assume the existence of extremely changeable, nutritive disturbances^ In 
many respects we are even in doubt with regard to the localization of 
these disturbances, though it is probable that they occur mainly in the 
central nervous system, but a peripheral localization is by no means ex- 
cluded for a series of symptoms (neuralgia, hypersesthesia, paralysis, 
etc.). 

Hysteria is also an affection which is curable with extraordinary diffi- 
culty, and this is due in part to the congenital neuropathic taint, in part 
to the constant presence of causal morbific influences^ whose removal is 
impossible. 



SP£OIAL SLECTRO-THJSBAPBimCS. 298 

The main object of treatment is the removal of the disease itself ie. 
of the morbid disturbance of nutrition of the nervous system. For this 
purpose, we may resort to general foradization, electrical baths, general 
galvanization ; likewise to galvanization of the spine with ascending stabile 
currents, the chief attention being paid to the cervical cord and sympa- 
thetic. On account of the extreme irritability of hysterical individuals, 
trial should be made of the application of feeble continuous currents along 
the spine (with a pair of galvanic elements). The disease, as a whole, is 
favorably influenced at times by treatment of the pressure points and pain- 
ful points along the spine and also by the treatment of ovarian hyperaes- 
theeia, as practised by Hoist (An upon the spine, Ca upon the painful 
ovary, stabile current) or according to the method recommended by Neftel 
in visceral neuralgias {vide page 258). 

In this treatment of hysteria special precautions must be employed. 
In scarcely any other neurosis do psychical i^tors play so in^xurtant a 
part as in thia Confidence in the physician and the remedy is the best 
guarantee of success, and you should endeavor, by all means, to secure 
this confidence, and not destroy it by the careless application of a strong 
current. Always begin with very feeble currents and applications of short 
duration. I have often thought it desirable to test the effect of the psy- 
chical impression upon such patients and have begun the treatment, 
therefore, by applying the electrodes in the proper manner without closing 
the circuit The statements made to us concerning the effects of such a 
sitting may be remiurkable, but they give a clear idea of how much must 
be attributed to imagination and mental excitement, and how much 
to the action of the current The confession of this deception may 
produce a decided psychical impression and thus hasten recovery in in- 
telligent patients ; in others, the opposite effect will be produced by 
such candor, since the offended vanity of the patient vnll not fcnrgive the 
physician. 

The treatoient must always be pursued slowly, intermitted at times^ 
and exoesmve irritation must be avoided. 

Symptomatic treatment possesses a wide field of action in the disease. 
It must be carried out aeeording to the methods previously described, 
though modified in certain respects by the general condition of the pa- 
tient. 

In hysterical pasalyses the methods ordinarily adopted in paralysis ore 
admissiUe. In eleetro-diagnostio respects I will mention merely that the 
electrical excitability of the motor nerves and the muscles is in no vnse 
changed, as a rule, and that the statement of Duchenne that the electro- 
muscular sensibility is usually extinguished, does not hold true by any 
means of all cases of hysterical paralysis. This feature is also observed 
oocasioDally in paralysis of a different origin. The therapeutic results in 
the hysterical form are sometimes (for example, in hysterical paralysis of 



294 BLEOTBO-THEBAPBUnCa 

the Tocal cords ') extraordinarily prompt and indeed magical, at other times 
thej are the yeiy reverse, so that long-continued treatment is necessary 
before recovery occurs ; this is especially true of paralysis occuiringin the 
form of paraplegia. 

In anaesthesia, the methods recommended in Lecture '^nCTY should 
be adopted ; the plan recommended by Yulpian, viz., the application of 
the local faradic brush to a circumscribed part of the skin of the fore- 
arm, sometimes has a brilliant effect in the not infrequent hemianaesthesia 
of hysterical individuals. 

In hysterical convulsions, electrical treatment is often useless, despite 
every possible method of application. In contractures, good results may 
be obtained sometimes from the galvanic current (descending stabile), 
sometimes from the faradic current ; likewise from the continued applica- 
tion of a feeble galvanic current (Lenoir). It is said (Richet^ Boux) that 
hystero^pileptic attacks are sometimes shortened and ameliorated by the 
passage of a stabile galvanic current (10 to 15 elements) from the forehead 
to any part of the body. Sudden change of polarity of a very strong 
galvanic current (40 to 50 elements Trouv^) applied in this manner, will 
terminate such an attack at once, but does not prevent its recurrence.* 

The globus hystericus may be treated by galvanization or faradization 
of the neck and pharynx, perhaps also by the passage of a current from 
the back of the neck to the epigastrium ; this is also useful in nervous 
vomiting, in addition to a vigorous application of the farado-cutaneous 
brush to the pit of the stomach. Faradization of the intestines may be 
resorted to in obstinate constipation and in hysterical iympanites. 

4. Epilepsy, — Hitherto this severe and mysterious neurosis has been 
made the subject of electrical treatment veith comparative infrequent^. 

The real nature of epilepsy is still obscure, despite all the clinical and 
ei^rimental investigations with regard to it and despite more or less in- 
genious attempts at its explanation. Even the localization of the disease, 
which had been referred to the region of the pons and medulla oblongata 
with tolerable certainty, is now rendered doubtf uL The recent observations 
upon cortical epilepsy seem to point to the motor parts of the cerebral 
cortex as the place of origin of epileptic convulsions. 

At all events, it is certain that the true site of epilepsy must be sought 
in the brain and that it is due to a peculiar disturbance within this organ, 
which is manifested from time to time by a sort of explosive discharge, t.e., 
by the epileptic attack. This disturbance, which is known as the '' epi- 

* In hystericfd aphonia Emmingbaos has sometimes obtained snooessfnl reenlta 
from galvanization transventely through the mistoid proceiiaes, bnt he is unable to 
decide whether this is due to a physioal or a psychical effect. 

* Static electricity has recently been tried in Paris (Charcot, Vigoaroox), and not 
without good results, in all poasible hysterical symptoms, as well as against thtt 
disease as a whole. 



SPECIAL ELEOTRO-THEBAPSUTIOa 295 

leptic change/' is dependent yery probably not upon gross anatomical 
changes but upon finer nutritive and molecular processes. 

Electro-therapeutic measures in epilepsy have been resorted to by Ta- 
rious writers, but they have not obtained many followers in this direction. 

As a matter of course the electrical current is powerless against the 
attacks themselves ; our endeavors must be directed entirely toward the 
removal of the ''epileptic change" in the brain This may be done 
directly or indirectly (by removal of its causes or by reflex action). 

In the former method the catalytic and vasomotor actions of the 
current are alone available, viz., direct applications to the head, the 
cervical sympathetic, and the cervical cord. Althaus recommends trans- 
verse galvanization through the mastoid processes, and galvanization of the 
sympathetic. In my recent experiments I have employed the following 
method : a stabile, very feeble current (4 to 6 elements) obliquely through 
the head, from the temporal region and upper part of the forehead on one 
side (Anode, large head electrode) to the opposite side of the back of the 
neck (Ca, large electrode), from one-half to one minute on each side ; then 
longitudinally from the forehead (An) to the back of the neck (one-half to 
one minute). In some cases, especially if the vasomotor symptoms are 
marked during the attack and also in the intervals, I add galvanization of 
the cervical sympathetic. 

Careful trial of faradic currents to the head also apx>ears to me to be 
justifiable, and they should be applied as in the treatment of mi- 
graine. 

General faradization may be employed for its indirect effects upon the 
brain. Althaus strongly recommends galvanic treatment of those periph- 
eral nerve tracts in which the aura is situated. If points of pressure or 
galvanic painful points are demonstrable, treatment should be directed 
toward them ; likewise if a neuralgia or a peripheral nerve injury, a cicatrix 
or the like is suspected as the starting-point of the epilepsy, even if it is 
not the site of an aura. 

Successful results are very scanty, but Althaus has reported some very 
striking cases. I have had a very &vorable impression in the few cases 
which I have treated electrically of late years, so that I am encouraged 
to renewed triab. But not until we are in possession of a large number 
of individual experiences will we be able to make more accurate indica- 
tions concerning the selection of cases for electrical treatment and the 
methods to be adopted. 

6. Under the term professional hyperkineses are usually included all 
those functional neuroses which present the common feature that, in 
certain complicated and delicate manipulations, disturbances of movement 
occur which interfere with the manipulation in question or render it 
entirely impossible. The so called writer a spasm is the type of theso 
neuroses, but analogous disorders may occur in other occupations, such as 



296 ELECTRO-THERAPEUTIOa 

drawing, sewing, playing upon the piano or violin, milking, telegraphy, 
making cigars, etc. 

There is no doubt that these neuroses do not constitute a constant 
form of disturbance but that they include various affections. In very 
rare cases distinctly localized spasmodic and paralytic conditions may be 
observed ; these constitute the more favorable forms in which the treat- 
ment has a definite point of attack. 

But tiie disease may be manifested in a variable form in the purely 
functional, typical varieties-as a definite spasm occurring during ^ 
(spastic form), or as tremor, or, finally, as increasing exhaustion and weak- 
ness of the hand and arm during writing (paralytic form). The charac- 
teristic feature of all these forms lies in the fact that examination reveals 
no further disorders of motion and sensation. Electrical examination, as 
«'i rule, shows no noteworthy change& 

We are still very much in the dark vdth regard to the real nature of 
these forms of disease ; they present undoubted intimate relations to 
neurasthenia, and are probably due to a localized irritable weakness of 
certain parts of the nervous system caused by over-exertion. This is situ- 
ated mainly in the central nervous system, though we are ignorant as to 
its localization in the spinal cord, the basal ganglia or cortex of the brain ; 
nor is the implication of the peripheral apparatus, the nerves and muscles, 
excluded with certainty. 

This uncertainty naturally reacts upon electro-therapeutic methods, 
since it may be assumed that various applications will be effective If 
any peripheral disturbance is discovered, such as paresis, atrophy of in- 
dividual musdes, neuritis, anaesthesia, etc., this must be treated first; 
when there is marked neurasthenia, endeavor to remove this if possibla 

In other respects, you must restrict yourself to direct treatment, 
especially to applications to the entire motor apparatus from the cerebral 
cortex to the muscles, if not at once, at least successively and methodically. 
At first, galvanic applications to the head (transversely, longitudinally, 
obliquely). Then, treatment of the cervical sympathetic and eqpecially of 
the cervical cord by various methods according to the character of the 
case (either ascending stabile, so that the Ca acts chiefly on the cervical 
cord, or stabile application of the An, as recommended in other forms of 
spasm). Finally, peripheral galvanization of the nerves and musdes 
(either more labile in the tremor-like and paralytic forms, or mainly with 
stabile currents, as in the spastic form). Relatively weak currents should 
always be employed, in order to avoid exhaustion of the motor apparatua 

Moritz Meyer has obtained very excellent results from the treatment 
of points of pressure upon the spinal column, the brachial plexus, etc., 
but unfortunately such points are demonstrable in very few instances. 
Wearing simple galvanic elements upon the arm and neck has seemed to 
me to possess at least palliative effects in individual cases. 



SPECIAL £LE0TBO-THEBAPEnTI0& 29 



^ 



Taradic treatment may be appropriate in certain eases, espeoiaUj in 
peripheral local affections of the nerves and mnsclea Local faradization 
mth moderately strong currents is asually indicated. 

On the whole, the results are yeiy meagre. Improvement in writing, 
etc., may be noticed for a variable period after galvanization, but it does 
not persist and in a small number of cases alone do progressive improve- 
ment and finally recovery occur. ThiA never takes place except after long- 
oontinued treatment and the most absolute abstinence possible from the 
injunons occupation. 

6. Chorea magna is a very peculiar neurosiB, which possesses^ it is true, 
a certain relationship with hysteria and the psychoses, but may undoubt- 
edly lay daim to independence. It is, on the whole, a very tmcommon 
disease, whiqh is still more rarely the subject of electrical treatment It is 
manifested by attacks of disordered consciousness, associated with ecstasy, 
vkdent oo-ordinated movements and spasms (shouting, dancing, singing, 
jumping, etc), which may present very bizarre forms and surprising per- 



We axe entirely in the dark with regard to the character of this 
ioiliailoe, but it is undoubtedly a functional disorder of the brain. 

Ihe purpose of deotro-tberapeutics in this disease can only be to pro- 
dnoe a general tonic action upon the nervous system (by general faradiza- 
tiott or galvanization, electrical baths, etc) and thus prevent a return of 
Am attacka It may also be justiftaUe to attempt the production of a 
sedative action upon the central nervous system by oarefol galvanic appli- 
•atfams to the head or by central mlvuuflitioB. 



LECTURE XX XL 

T. Chorea Hinor : Its Situation and Character ; Eleotrioal Treatment — 8. TetaaiiB : 
Methods of Treatment—^. Tetany: Its CharaoterisUos ; Eleotrioal Bzoitabillty ; 
Character and Location of the Disease; Electrical Treatment — 10. Catalep^f— 
11. Tremor— 12. Paralysis Agitans— 13. Athetosis— 14. Basedow's EHmms: 
Symptoms and Location of the Disease ; Methods of Electrical Treatment— 15. 
Vertigo— 16. Diabetes MeUitns and Insipidus. 

7. Chorea minor, — ^This extremely frequent neurosis has often been 
the subject of electro-therapeutio trials and with undoubted benefit. 

In many respects this is also an obscure affection. It is probaUj 
localized in the brain, though this is by no means entirely certain, and an 
implication of the spinal cord is not excluded. In ordinary cases it is 
probably merely a functional nutritiye disturbance, but gross anatomical 
changes are found occasionally. It is eyen doubtful whether the peculiar 
characteristics of the abnormal muscular contractions are dependent on a 
definite kind of irritation or upon a definite situation of the affection 
which has given rise to the irritation. 

The ctymptomatology of chorea is so well marked that it can rarefy be 
mistaken. Electrical examination offera no characteristic results. It has 
been stated repeatedly that in chorea the faradic and galvanic excitabilify 
of the motor nerves is increased (Benedikt, M. Rosenthal, Gk>wers), and 
that this can be demonstrated very readily in fresh cases of hemichorea. 
Despite very careful examination I have been unable to satisfy myself of 
the truth of these statements. The painful points upon the spine and 
various peripheral nerves, discovered by Bosenbach by means of the gal- 
vanic current in one case, are present in very few instancea 

Various methods have been employed in the electrical treatment of 
chorea minor. I make applications to the head so that the motor zones of 
the brain are situated directly between the electrodes, ie., obliquely from 
the region of the central convolutions {vide Fig. 29, anode, large head 
electrode) to the opposite side of the neck (Ca, large electrode), for one- 
half to one minute on each side with a feeble current (4 to 8 Stoehrer's 
elements) ; or, in the manner recommended by O. Berger, with a bifur- 
cated An upon both parietal regions, the Ca being placed in the hand or 
upon the back for five to ten minutes. In addition, galvanization of the 
sympathetic and the cervical cord may be performed in order to produce 
indirect catalysis. 



SPECIAL ELE0TBO-THSBAPEUTIC& 299 

Others baye specially recommended applicatioDS to the spinal cord with 
feeble ascending currents, applied partly stabile, partly labile. Morits 
Meyer, on the other hand, treated his cases with twenty-four to thirty in- 
iermptions of a strong current and Leube has also employed successfully 
a -very strong current 

If points of pressure can be demonstrated, their treatment in the or- 
dinary manner (An stabile) is usually attended with great benefit (M. Meyer, 
Bosenbach). 

The faradic current was much employed in former times, but not veiy 
successfully ; general faradization may be recommended, particularly in 
cases of relapsing chorea in nervous children. 

The results of these methods of treatment are determined with diffi- 
culty in a disease of such variable intensiiy and duration as chorea. In 
my own experience brilliant results have not been obtained. No good 
effects have ever been secured in old cases of chorea in adults ; the recent 
chorea of children, on the other hand, has been benefited very decidedly 
by electrical treatment and materially shortened in many cases. 

8. Tetanus has rarely been the object of electrical treatment It seems 
indeed hazardous to employ electricity, an irritant par excellence, in such 
a terrible spasmodic affection, in which every cutaneous irritation is usu- 
ally followed by a fresh outbreak of convulsions. However, our knowledge 
of the sedative action of the galvanic current and of its reflex inhibitory 
influence upon the spinal cord (Eanke) might lead us to venture its appli- 
cation in this grave disease ; and indeed some strikingly favorable results 
have been reported. Great caution must be exercised, however, in this 
respect because so many cases of tetanus recover spontaneously. 

The location and nature of tetanus have not up to the present time, 
been entirely cleared up ; the constantly recurring attempts to attribute 
tetanus to gross anatomical, inflammatory processes in Uie spinal cord, 
have not gained general acceptance hitherto. Nevertheless, it is located 
most probably in the spinal cord (including certain parts of the medulla 
oblongata), although no gross changes can be discovered. 

Mendel observed recovery in two undoubted cases of tetanus which 
had been ^stematically treated by galvanism ; he applied the An to the 
muscles or integument of the extremities, the Ca to the spine above the 
cervical and lumbar enlargements (the direction of the current sometimes 
reversed), feeble stabile currents being passed for a few minutes. The 
tetanic stiffiiess disappeared quite rapidly, the improvement continued 
after the sitting and gradually progressed to recovery. Whether the re- 
coTery in these cases was due to the action of the current upon the spinal 
cord, the muscles, or the peripheral sensory nerves can not be decided. 
Legros and Onimus report a case of tetanus which recovered under the 
use of very large doses of chloral and the application of the galvanic cur- 
rent» from which it appears that the employment of descending stabile 



800 KLECTBO-THEBAPEtmCJS. 

gahranic currents upon the spine has a favorable effect upon the spasm iir 
self, relaxes the muscles and produces a feeling of relief ; one to three 
sittings were held daily, the duration being one to two hours ; the current 
should not be too strong and the electrodes very large. 

From these few data definite conclusions can not be drawn conoeming 
the therapeutic value of electricity in tetanus. In this disease I should be 
inclined to employ the direct action of the galvanic current upon the spinal 
cord, at first with the anode, perhaps later with the descending current ; 
feeble stabile currents, applied for a long time. Judging from Mend^'s 
experience, the An should also be applied to the peripheral parts, ei^- 
cially to the sensory and mixed nerve trunks. At all events further ex- 
periments shotdd be made in this direction. 

9. Tetany, — The peculiar and not infrequent form of spasm known aa 
tetany is a much more favorable object of electro-therapeutic experiments. 

It is a spasmodic disease, manifesting itself by periodical and parox- 
ysmal painful tonic spasms of certain groups of muscles ; it affects chiefly 
the upper limbs, more rarely the lower extremities, sometimes other mus- 
cular groups of the trunk and head. 

Careful observations have shown that a marked increase can be demon- 
strated in the excitability of the affected motor nervous apparatus. This 
is manifested by the occurrence of the characteristic spasms upon com- 
pression of the large nerves or arteries of the limbs (Trousseau's symptom) ; 
no less by the marked increase of the mechanical excitability of the nerves 
and muscles, and finally by the increased electrical excitability of the motor 
apparatus. This is found in almost all the nerves of the body, most mark- 
edly in those directly affected by the spasm. Upon the faradic examina- 
tion, the nerves react to an extraordinarily feeble current ; upon galvanic 
examination, Ca CI C appears extremely early, likewise An O C : Ca d Te 
and An CI Te occur very soon and, what is especially important and char- 
acteristic. An O Te is often produced with great facility. This increased 
excitability occurs not alone during the attacks but also in the inteiparox- 
ysmal period. 

Anatomo-pathological examination has furnished no satisfactory data 
with regard to the character and situation of the disease. A critical con- 
sideration of the symptomatology renders it probable that the condition is 
due to markedly increased excitability of a large part of the motor appara- 
tus, the starting-point being probably in the anterior gray substance of 
the cord (with or without implication of the gray motor nuclei in the me- 
d\illa oblongata). 

The most rational method of treatment would seem to be the stabile 
application of the An (the strength of the current being gradually in- 
creased and diminished) to those parts which are the site of the disease, 
viz., the cervical cord especially, the entire spinal cord, the individual 
nerve-trunks (Ca upon the sternum). All these parts should be treated 



SPECIAL SLEOTRO-THERAPSUTICS. 801 

throughoat their entire extent, the peripheral nerves being treated bj ap- 
plying the An firet in the neighborhood of the musoles and then alowlj 
passing upward to the plexus. 

It must not be forgotten that other methods of application may also 
prove useful ; for example, Ca stabile with rapid Ca O, etc. These should 
be tried if the first method proves uselesa 

Nor is there any objection to a trial of the faradic current : faradiza- 
tion of the spine with large electrodes and moderately stnmg currente, 
likewise of the nerve-trunks. 

It goes without saying that anodal applications should be made during 
the attacks, and I believe that I have observed repeatedly an immediate 
improvement and abbreviation of the attacks. Eisenlohr has also noticed 
repeatedly this immediate sedative action of the anode. As a matter of 
course, it must be continued during the intervals and for some time after 
the cessation of the attacks, until Trousseau's phenomenon or the marked 
increase of electrical excitability has disappeared. 

Very many observations have not been made with regard to the results 
of electrical treatment in tetany ; almost all of those reported hitherto 
ha^e been IsTorable. 

10. Catalepsy. — ^In this remarkable form of disease, no opportunity of 
achieving great triumphs is offiared to electro-therapeutics. On account 
of the great rarity of the affection and the manifold combinations under 
which it i^pearSy the possibility of extended and careful therapeutic in- 
yestigations is excluded almost entirely. 

Electricity has been employed sometimes in catalepsy as a vigorous 
irritant with the purpose of thus rousing the patients from their trance. 
Indeed, this may prove successf ul, and, as a matter of course, the free use 
of the &radic brush is advisable. Vigorous faradization of the nerve 
trunks and muscles may also be employed. 

As a curative remedy proper in catalepsy, electricity must be applied 
mainly to the central organs of the nervous system. In such cases, I have 
first employed central galvanization, then galvanization of the head and 
cervical sympathetic, perhaps vigorous galvanization and faradization 
along the spine, but usually without any noticeable effect. 

11. T}remor. — ^This symptom may appear in various forms and from 
manifold causes. I now refer to those varieties alone which occur vrith a 
certain degree of independence, such as senile tremor, the various kinds 
of toxic tremor (alcoholic, mercurial, lead tremor), the neurasthenic tre- 
mor which is so frequent in nervous persons, tremor after acute diseases^ 
idiopathic tremor of individual extremities, etc. 

The majority of these forms of tremor produce the impression of irri- 
table weakness, of an insufficient, oscillatory execution of individual move- 
ments and not of a true spasm. 

Much benefit cannot be obtained from electrical treatment. The 



302 KLE0TRO-THBBAPEUTIC8. 

choice of the method of application depends ux)on the general symptoms 
and the demonstrable etiological factor& As a rule, a moderately stimu- 
lating, invigorating method of treatment should be chosen. 

In local tremor moderate galvanization or faradization of the aflfected 
parts and the corresponding region of the central nervous ^stem ahonld 
be performed and repeated regularly until recovery ensues. As it occurs 
chiefly in the upper limbs, treatment of the cervical cord (perhaps also ol 
the bndn) and direct electrization of the nerve-trunks and muscles of the 
upper limb with moderately strong currents are indicated. Excellent re- 
sults are sometimes obtained in this manner {vide Observation 125). 

In general tremor, especially in those varieties dependent on toxic in- 
fluences, more reliance may be placed upon general methods of treatment^ 
either central galvanization or general faradization. The electrical bath 
is highly extolled by French writers in toxic tremor, especiallj in the 
alcoholic and mercurial forma Paul gives such patients a toadic bath, 
half an hour in duration, eveiy two days. 

The results are often very unsatisfactory, and I have treated, without 
avail, many cases of tremor after typhoid fever, etc, vnth all possible 
methods. 

12. Paralysis agitans, — Undoubtedly the most severe and obstinate 
form of tremor is paralysis agitans, an independent neurosis of extremely 
characteristic and typical symptomatology. It is a disease of advanced 
life, the situation and character of which are quite obscure, though it has 
been rendered more probable recently that it is a disease of the brain. 

This afiection, into the clinical history of which it is imnecessaiy to 
enter, appears to be incurable ; the reported cases of recovery are prob- 
ably due to erroneous diagnosis. We cannot expect more than a passing 
relief, or, at the most, a temporary stand-still of the disease. 

The method of treatment consists in galvanic applications to the head 
(obliquely and longitudinally, with large head electrodes), likewise to the 
sympathetic and cervical cord ; in addition, descending stabile and mod- 
erately labile currents through the peripheral nerves and the mnsdea 
Central galvanization or general faradization may be tried, perhaps, in 
individual cases. 

13. Athetosis, — This spasmodic neurosis sometimes occurs idiopath- 
ically, but more frequently after cerebral hemiplegia, and it is then 
related to post-hemiplegic chorea and the analogous tremor. It consists of 
peculiar restless, twitching movements, and a characteristic position of ^e 
hand and Angers, less often of the arm, and sometimes of the foot and leg. 

The location and character of this disturbance are not known with 
certainty. It is generally assumed to be caused by an aflection of the 
brain, though its spinal origin does not appear to me to be positively ex- 
cluded. At all events, it is uncertain whether this peculiar afiection is due 
to a definite location or merely to a definite character of the irritation. 



SPECIAL ELEOTBO-THEEAPEUnCS. 803 

The electrical treatment conmsts usually of galvanization of the head, 
the cervical cord, and the sympathetic, according to the well>known meth- 
ods ; also the An stabile to the back of the neck, the Ca upon the princi- 
pal nerve trunks of the extremities. Gnauck obtained recovery in one 
case by the application of descending stabile currents to the cervical cord 
and the musdes. I have treated a number of cases without success ; in 
one girl of twenty, suffering from bilateral athetosis following cerebritis, 
prolonged treatment produced at least distinct improvement and in- 
creased power of using the handa 

14. Basedoio's disease. — ^This rather frequent neurosis is characterized 
by exophthalmos, a pulsating enlargement of the thyroid gland and palpi- 
tation of the heart, although one or another of these symptoms may be 
absent occasionally. In addition, there are usually numerous other ner- 
vous symptoms, marked nervous exhaustion and irritabiliiy. All the more 
recent investigations indicate with increasing certainty that the disease is 
very probably located in the upper part of the cervical cord and in the 
medulla oblongata. The affection is probably a functional neurosis ; at 
all events, it presents generally a tendency to recovery, although some- 
times followed by permanent sequelse. 

Electrical treatment must be directed to the cervical cord and the 
medulla oblongata ; applications to the sympathetic and pneumogastrio 
may also be made in order to combat the principal symptoms. 

The galvanic current is employed almost exclusively. Above all, the 
application of ascending stabile and labile currents to the cervical cord ; 
An between the scapulae, Ca in the neck and along the entire cervical 
spine ; very feeble currents (6 to 8 Stoehrer's elements) are recommended 
for one or two minutes. At the same time, I have often passed the cur- 
rent transversely and obliquely through the head, in order to affect the 
medulla oblongata directly ; also with very feeble currents of short dura- 
tion. Finally, regular galvanization of the sympathetic and pneumogastric 
in the neck in the ordinary manner ; the An upon the cervical spine, the 
Ga upon the nerves from the lower jaw to the clavicle. When the affec- 
tion was supposed to be located in the sympathetic, this method was 
adopted almost exclusively by certain observers, and furnished numerous 
good results (Moritz Meyer). This application is said to be especially effi- 
cacious when the heart s action is violent and abnormally frequent 

Direct galvanic appUcations have been made in this disease to the 
enlargement of the thyroid gland, and with success in some cases ; trans- 
verse passage of the current through the tumor or a brief, and, not too 
feeble, application of the Ca is advisable. 

To relieve the exophthalmus I have repeatedly employed transverse 
conduction of a feeble galvanic current through the orbits, from temple 
to temple, and, at the same time, longitudinal conduction from the neck 
to the closed lids — whether with real benefit I do not venture to decide. 



1 



804 ELEOTBO-THSBAPSUnOS. 

The ordinary methods of appUoation are employed in the pareee8<rf the 
oeular muscles, which are present in almost all severe oases. 

The undoubted dose relations of Basedow's disease to neurasthenia^ and 
the ordinary occurrence of neurasthenic symptoms may lead very readity 
to the use of the methods, such as general faradization, ordinarily employed 
in the latter disease. 

As a matter of course, the medicinal, dietetic, and balneological 
ment of the affection should not be neglected. 

The results of galvanic treatment in Basedow's disease are by no 
bad. A reduction in the frequency of the pulse is not infrequently notice- 
able forthwith, or it may occur gradually during the course of treatment. 
But the entire symptomatology is often very rapidly imjm>ved, and the 
subjective complaints of the patient relieved. As a rule, however, the 
treatment must be continued for a long time (thirty to one hundred sit- 
tings or more). The exophthalmus often persists for a very long time, 
and defies all treatment ; this is less true of the enlargement of the thy- 
roid gland. 

15. Vertigo. — Little can be said with regard to the electxical treatment 
of vertigo. In the large majority of cases it is merely a symptom of the 
most varied diseases, both of the central nervous system, as well as the 
vasomotor nerves, and, perhaps, also of other organs (reflex vertigo, in- 
cluding stomachal, ocular, labyrinthine vertigo, Meniere's disease, etc.). 
The main feature in all these cases is the treatment of the pnmary dis- 
ease ; vertigo will rarely be treated as an isolated sjnmptom in these afibc* 
tions. 

Not infrequently, however, vertigo does occur, to a certain extent, in 
an isolated manner and constitutes the principal, and, to the patient, most 
striking symptom. Cases are not infrequent in practice in which we are 
consulted with regard to vertigo, while careful examination reveals no 
special abnormality, and the cause and pathogenesis of the symptom 
remain obscure. In such cases the vertigo may be treated by electrical 
applicationa As the intracranial organs are the immediate points of ori- 
gin of vertigo, galvanic and faradic applications may first be made to the 
brain, and then galvanization of the sympathetic. When symptoms of 
circulatory disturbances within the skuU are present, the cerebral circula- 
tion may be influenced in a reflex manner by the fturado-cutaneous brush. 

16. Diabetes mellitus and insipidus, — ^Electro-therapeutic measures have 
been adopted very little in diabetes mellitus, and, as it seems, with very 
poor success ; my own results have been entirely negative. Neftel, how- 
ever, reports a very favorable result in a woman who had suffered lor 
several years from advanced diabetes (nine per cent, sugar under mixed 
diet) and in whom galvanization of the brain (according to NefteVa 
method) produced remarkable improvement, so that aU the subjective 
symptoms disappeared, and the amoimt of sugar sank to one per cent. 



SPECIAL BLBOTRO-THEBAPBUnCS. 805 

Beard reports improyement in two cases from central galvanization ; Le 
Fort reports considerable improvement from the permanent application 
of a feeble current of two elements from the neck to the liver. 

The methods of application follow naturally from the current theoreti- 
cal views concerning the development of neurotic diabetes mellitus : treat- 
ment of the cervical cord and medulla oblongata in the ordinaiy manner, 

and likewise galvanization of the sympathetic ; feeble currents for a few 

« 

minutes daily. 

The electrical current has been employed much more frequently in 
diabetes insipidus, and a few successful cases which have been reported 
should stimulate us to further attempts. Seidel rex)orts a favorable re- 
sult in a case which had lasted more than a year ; energetic galvanization 
of the region of the kidney produced very rapid improvement and in the 
course of a few weeks recovery, vdth an increase in the weight of the 
body. Althaus reports a recovery in a long-standing case from a single 
application to the medulla oblongata. 

Treatment should be directed mainly to the central nervous system (the 
medulla oblongata and cervical cord) and also to the region of the splanch- 
nic nerves, the dorsal cord and sympathetic ; galvanic applications should 
first be resorted to. Seidel made his application directly to the region of 
the kidneys; one electrode (which?) was placed in tlus region, to one 
side of the spinal column, the other was pressed deep into the hypochon- 
drium, anteriorly at the same level ; a strong galvanic current was ap- 
plied for five minutes on each side. 

Qeneral faradization or central galvanization may be advisable in some 
cases. 

I myself have made an entire series of e]9eriment8 in diabetes insipi- 
dus, but my results have been negative 
20 



X. DISEASES OP THE ORGANS OP SPECIAL 

SENSE. 



LECTUEE XXXn. 

Introduotioii— Diseases of the Visnal Apparatus : Their Electro-diagnosls^DiseMes of 
the Lids, Oonjonctiva, Cornea, Iris, Lens, Yitreoas Body, Ohoroid — Diseases of 
the Retina and Optio Nerve : Retinitis Pigmentosa ; Papillitis and Papillo-reti- 
nitis ; Optio Neuritis ; Cases ; Method of Treatment — Atrophy of the Optio 
Nerve : Tabetio and Genuine Atrophy ; Cases ; Treatment — Amaurosis without 
Anatomical Lesion — Hemianopsia — Diseases of the Ocular Muscles : Luuffloienoj 
of the Intemi ; Accommodative Asthenopia ; Mydriasis ; Nystagmus. 

With reference to the organs of special sense, electro-therapeutics 
fiatiiraDj deals mainlj with the purely nervous affections of these organs ; 
that it may also be employed in other forms of disease will be indicated 
in brief in -the following section. 

I will begin with the visual apparatus. The remarkable development 
of ophthalmology in the last few decades has thrown into clear relief the 
great importance of diseases of the eye, not alone in practice but also 
with reference to pathology. Particularly the so-called nervous affections 
of the eye, both those which affect the true sensory apparatus, the optic 
nerve and retina, and those involving the neuro-muscular apparatus, have 
acquired the greatest importance in neuropathology. Neurologists recog- 
nize this fact more and more from day to day, and the great frequency of 
nervous diseases of the eye as prodromata, part-symptoms and sequelae of 
many important affections of the nervous system and also of some other 
general diseases, has led to special study and treatment of these diseases 
on the part of specialists. 

As a matter of course, electro-therapeutics has also been relied upon 
for these objects, but its part in the treatment of nervous diseases of the 
eye is still comparatively slight, and is probably underestimated by 
many. Still sHghter is its significance in the treatment of all non-ner- 
vous affections. 

The actions of electrical currents in diseases of the eye are similar to 
those in diseases of the central and peripheral nervous system which have 
been so often described. The undoubted relations which mat between 



8PE0IAL ELECTBO-THEBAPEUTICS. 807 

the cerrical sympathetio and cervical spinal cord on the one hand, and the 
structures within the orbit on the other, and the influence which appears 
to be exerted bj the trigeminus upon the circulation and nutrition of the 
eje, should be borne in mind in the consideration of electro-therapeutic 
methods. 

I will now describe the treatment of the individual forms of disease, 
80 far as thej are amenable to the action of electrical currents. 

Very little can be said with regard to diseases of the lids and conjunctiva. ' 
Dutrait treats certain forms of entropium and ectropium, which he attrib- 
utes to atony and atrophy of individual bundles of the orbicularis palpe- 
brarum, by careful faradization of these muscular bundles. A fine electrode 
is employed, and those bundles, whose contraction produces restoration ot 
the false position of the lid, are treated patiently for a long time. 

Bodolfi has found the dynamico-chemical eflects of the galvanic current 
useful in trachoma. He applies the Ca in the form of a copper olive-tipped 
sound to the granulations of the everted lids, while the An (a moistened 
sponge electrode) is placed upon the inferior maTilla (current from two 
Bunsen's elements). The results were very satisfactory in a series of cases, 
the granulations disappeared after a few sittings, but relapses were not 
entirely prevented. Bodolfi attributes Arcoleo's bad results in this disease 
to his defective method. Smith has also recommended catalytic treatment 
of trachoma. He applied both electrodes, in the shape of suitably bent 
vrires separated about five millimetres from one another, directly upon the 
conjunctiva (current from two elements, one half to one minute upon each 
lid). 

Diseases of the cornea were treated electrically by Arcoleo almost ex- 
clusively by means of the faradic current The positive pole is placed on 
the neck or hand, the negative (in the shape of a small sponge or brush) 
directly upon the conjunctiva and cornea, or upon the closed Hds by means 
of a broad sponge ; Arcoleo employed the galvanic current very rarely. 
Daily sittings were held, lasting five to eight minutes. Very good results 
were obtained in parenchymatoiis keratitis (application of the brush to the 
conjunctiva, atropine being introduced sometimes). The cornea began to 
clear up after a few sittings and more or less complete recovery gradually 
ensued. A brilliant result was obtained in a case of epithelial keratitia 
He also states that very good results were obtained in corneal ulcers by the 
same method, the bottom of the ulceration being touched lightly with the 
hair brush two or three times during each sitting. In one very old case 
of whitish opacity of the entire cornea I employed this method for a very 
long time without noteworthy effect, but it did not yield to any other 
method of treatment. In one case of beginning neuro-paralytic keratitis and 
conjunctivitis {vide Observation 132), due to paresis of the left trigeminus, 
I observed decided benefit from galvanic applications to the eye (Ca stabile 
and labile upon the closed Hds). Bri^re reports a recovery in parenchyma- 
tous keratitis in a few weeks from galvanic appHcations (4 to 6 elements) 
and Chvostek had admirable i*esults in a case of keratitis pannosa from 
persistent galvanization of the sympathetic 

Among diseases of the iris, apart from its nervous affections, hypopyon 
appears to be the only one which has been repeatedly made the subject of 
electro-therapeutic experimenta Arcoleo speaks very highly of the miudic 



308 ELECTEO-THEBAPEUnOS. 

currents ; a fine sponge electrode is applied directly to the lower border of 
the cornea, and touches the region of the purulent deposit three or four 
times during the course of the sitting ; after the sitting atropine is applied 
and this is followed by congestion of the conjuncthra. Marked diminution 
of the hypopyon is said to become apparent upon the following day ; mild 
cases are said to have been cured in a single day, more severe ones in four 
to seven days (twenty cases). Weisflog has also observed very good effects 
from his method of faradization (large sponge electrodes upon the closed 
lids, six to eight half hourly sittings daily) in five cases of hypopyon, and 
also reports an extremely rapid recovery in a severe, acute iritis from 
three hourly faradizations daily. 

Among diseases of the lens cataract has been drawn recently into the 
domain of electro-therapeutics. Neftel created no little excitement in the 
ophthalmological camp by a report of two case of undoubted beginning 
cataract in which all the symptoms of cataract were relieved by methodical 
gfdvanic treatment and the visual power restored completely. After a 
sharp criticism of these statements by Hirschberg, Neftel acknowledged 
that the opacities in the lens, demonstrable with the ophthalmoscope, had 
not disappeared entirely, and explained the undoubted improvement of the 
eyesight to the removal of a molecular opacity, which was not recognizable 
upon ophthalmoscopic examination. He adds also that galvanic applica- 
tions exert an influence, though not to a great extent, upon the opacity of 
ripe cataracta 

This subject is, therefore, still in its infancy, but its great importance 
justifies furtner careful experiments, mainly with reference to beginning 
cataract 

The following is the method employed by Neftel : An stabile in the 
neck, Ca stabile and labile upon the closed lids ; begin with five elements ; 
then pass the current in the opposite direction. This procedure should 
be repeated, with an increment of one element, until fifteen elements are 
reached ; duration of sitting ten to fifteen minutes, at first daily, then 
less frequently. 

The electrical current has been employed, and not without success, in 
diseases of the vitreous body, especially opacity. As is well known, opacities 
may be produced by various morbid processes and thus possess a variable 
pathological significance. They may be due to extravasations of blood, 
mflammatory products, degenerative processes, pus, cicatrices, etc. 

Giraud-Teulon appears to have devoted most attention to the galvanic 
treatment of these forms of disease. In a prehminary communication, he 
has stated recently that the galvanic current is the most effective and rapid 
curative measure in the majority of opacities of the vitreous, and Onimus 
has also published a series of favorable reports. Boncheron and LeFori 
have also reported some cases. 

From the observations made by these writers, there seems to be no 
doubt that the galvanic current exercises a certain influence upon opacities 
of the vitreous, and that rapid and more or less complete recovery may be 
effected by means of its employment in not a few cases, which had long 
been ti'eated without benefit by other remedies. 

The methods employed by different authors vary greatly. Le Fort 
makes constant application (both day and night) of the electrodes of two 
feeble elements to each temple ; Giraud-Teulon applies the An of 8 to 10 
Daniel's elements to the closed Hds, the Ca behind the ear, for two to 
four minutes ; Onimus applies the Ca to the closed lids, the An to the 



SPECIAL ELECTBO-TKEBAPEUnOS. 309 

corresponding sympathetic, 8 to 12 elements, stabile, for two to five min- 
utes. It follows, ilierefore, that the essential feature is merely the pas^ 
sage of the galvanic current through the eye, and this conclusion agrees 
with our general notions concerning the production of catalytic actions. 
For future trials I would recommend the passage of a current from the 
closed lids to the back of the neck, with a change in the direction of the 
current, either the poles being alternated at each sitting or the An alone 
being employed in one sitting, the Ca in the next ; feeble currents (4 to 
10 Stoehi^r's elements), stabile application for two to five minutea 

Dor reports some very encouraging results in diseases of the choroid. 
The most suitable cases for electrical treatment are said to be those in 
which, after a disseminated choroiditis, atrophic changes develop in the 
retina with scotoma, etc., after the lapse of months or years, and those in 
which there are numerous accumulations of pigment, plastic exudation 
and spots of atrophy. He treats them with the galvanic current trans- 
versely through the temples, or, in a unilateral afiection, from the supra- 
orbital arch to the mastoid process of the same side. 

140. Observation by Dor, Chronic retino^horoidUis, — A man, aged 
thirty-six years. Sick for two years ; treated unavailingly with all possible 
remedies (venesection, mercury, iodide of potassium, diaphoresis, issue, 
baths, eta ) ; must be led around. Diagnosis : disseminated choroiditis with 
numerous accumulations 6i pigment and secondary changes in the retina ; 
papilla somewhat reddish, sharply defined. Large central scotoma on 
both sides. Y. on both sides. No. C in the immediate vicinity. At first 
treatment with Heurteloup's, and improvement to xV,- (with excentric fixa- 
tion) ; then stationary condition. Galvanic treatment : after three weeks, 
patient reads all letters in YII., some m VI. Intermission of five months ; 
reads letters of YIL Strychnine for a week, without change. Galvanic 
current : after two days, letters of VL ; after a week, of IV. ; six weeks 
later, reads all letters of IQ. ; improvement in right eye alone, the sco- 
toma diminishing steadily. After May 29th central vision (No. XL.) pos- 
sible. July 8th, No. XX. ; August 24th, No. V. The left eye, which was 
affected first, did not show improvement until after forty-five days elec- 
trical treatment (May 29th). July 18th, left eye. No. XV. (excentric) ; 
August 24th, No. VL ; the central scotoma markedly smaller. 

The diseases of the retina and optic nerve are by fax the most important 
to the electro-therapeutist, partly on account of their frequency and 
pathological significance, partly also on account of the niunerous good re- 
sults effected by the electrical current in these affections, especially in the 
simple inflammatory processes and their sequelaE?, furthermore in purely 
functional disturbances without anatomical change, to a less extent in 
primary degenerations and atrophy. 

Dor has obtained very good results in a number of cases of retinitis 
pigmentosa by means of the galvanic treatment described above ; Neftel 
also reports a favorable result. 

In papiUitis and papHlo-retinitis (usually called choked disc), as it occurs 
in so many diseases within the skull, especially in tumors and meningitis, 
much cannot be expected from electrical treatment (although Driver states 



310 ELEOTBO-THERAPKUnOS. 

that he has seen good results from galvanization of the sympathetic in this 
symptomatic neuro retinitis) so long as the process is progressing and the 
pdmary disease is not relieved. But it may be hoped (and individual ob- 
servations favor this view) that the electrical current may prove very useful 
and produce considerable improvement of vision in the sequelae of thia, 
disease, after the termination of the primary affection ; the treatment is 
then the same as in every optic neuritis with secondary atrophy. 

Optic neuritis in its various forms and terminations is probably the 
most grateful object for electrical treatment among all the anatomical af- 
fections of this nerve. 

In optic neuritis and atrophy of the optic nerve, Pflueger has seen a 
number of good and, in part, brilliant results from galvanic treatment, 
but furnishes no details concerning the method of application. 

Leber recommends treatment of the sympathetic in the congenital af- 
fections of the optic nerve described by him, and which are known as re- 
trobulbar neuritis (vide Observation 49, page 184). In a number of 
similar cases, however, this favorable result was not obtained. 

In a case of descending optic neuritis, followed by amblyopia with the 
ophthalmoscopic appearances of atrophy of the optic nerve, associated with 
transverse dorsal myelitis, I obtained a very satisfactoiy result from le^ 
peated galvanic treatment 

141. Personal observation. Optic neuritis and svbactUe dorsal myeliiis. — 
A man, aged fifty-two years, in February, 1877, became blind quite n^udly 
in the left eye, sight being restored after a few weeks ; shortly afterward, 
a similar affection of the right eye, followed by improvement. After 
some time, relapse in both eyes advancing to complete amaurosis ; oph- 
tiialmoscope shows distinct appearance of optic neuritis with beginning 
atrophy. Slow improvement from the middle of June. At the end of 
June, symptoms of transverse dorsal myelitis which led (end of July) to 
complete paraplegia, with anaesthesia, paralysis of the bladder, increased 
tendon and cutaneous reflexes, ete. Improvement in all these symptoms 
from beginning of August, 1877 ; at the end of September, patient can 
walk a few paces. Slow progress of improvement in sight. 

November 12, 1878. — After the sight had remained stetionary for a 
long time, galvanic treatment was begun. Status on this day : pupiLs quite 
small, react te light ; slight myopia of both eyes ; R E., V . ^ ; L. K 
somewhat less, V. J . With -h 3, right, J. No. 3 ; left, J. No. 6, slowly 
recognized in a few words. Both eyes blind to red and green. Atrophy of 
both optic nerves with slight atrophic excavation, more marked on left 
side. Method of treatment : 4 te 6 Steehrer's elements transversely 
through the temples, 6 to 8 elements, from the neck to eyes, stebile, three 
to four minutes daily. December 10th : both eyes undoubtedly better. 
March 4th : R R. V. W^ ; L. E., V. „?t^. With 4- 3, reads J. No. 3, 
and some words of No. 2 ; with +4 and 5 reads newspaper print readily. 
Treatment discontinued. Similar treatment repeated at a later period 
produced no noteworthy improvement, but the patient can now write and 
read ordinary print 

142. Observation by Bump/, Optic neuritis with transverse myelHis. — ^A 



SPECIAL BLEOTBO-THEBAPBUnOS. Sll 

woman, aged thirty-seven years. Sick about two years ; paresis of low^r 
limbs, totters on closing the eyes ; parsesthesisB, diminished sensibility of 
legs, cincture feeling, increased tendon reflexes, incontinence of urine. 
Impaired vision (reads J. No. 14 with difficulty). Ophthalmoscope shows 
appearances midway between choked disk and optic neuritis, viz., swelling, 
cloudiness, intense injection of papilla, dilatation of arteries and veins. 
Treatment with the faradic brush (vigorous, slow strokes over the chest, 
back, and upper limbs). Besult very brilUant ; injection of nerve slighter 
on third day, then the swelling of the papilla diminished ; J. No. 7 could 
be read on the sixth day. After twenty-eight sittings, the symptoms of 
myelitis disappeared ; patient now reads J. No. 3 ; ophthalmoscopic ap- 
pearances normal 

148. Personal observoHon, Neuritis wUh atrophy of the optic nerve. — 
A man, aged twenty-one years. Came tmder treatment December 2, 

1880, for amblyopia, which had existed for several months and had de- 
veloped quite rapidly. Ophthalmoscope shows optic neuritis with transi- 
tion into atrophy ; marked amblyopia, can scarcely count figures ; field of 
vision considerably narrowed. Treated vnth extract nucis vomica, and 
galvanic current ; 6 elements transversely through the temples, 6 to 8 ele- 
ments from the neck (An) to the closed lids (Ca stabile and labile), also 
to the cervical sympathetic two to three minutes daily. January 10, 

1881, patient states that sight is decidedly improved ; with the left eye 
recognizes upon Snellen's tables the letters from D = 9 very well, D = 6 
in part ; with right eye, D = 9 only in part. Colors : green very uncer- 
tain, red quite so, blue and yellow distinct, but not entirely nonnaL The 
ophthalmoscopic appearances better. February, 27th : L. K, D = 1 veiy 
well ; R K, a few letters of D = 4 ; patient can read a few words with the 
left eye ; field of vision still very small, he is again able to walk alone upon 
the street March 24th, left for Switzerland. Returns improved two 
months later. 

I have incomplete notes also of several other cases in which galvanio 
treatment was useful, at least to a certain extent, but I must also mention 
an entire series of negative results. Benedikt also reports a number of 
favorable results in neuro-retinitis and optic neuritis. 

The method of treatment readily follows, from the indications which 
are presented ; as catalytic action is required, stabile currents vnll be em- 
ployed in the main and should be applied as directly as possible to the 
eye and optic nerve. In the first stages the An is preferably applied to 
the eye ; later, when the process is tending toward atrophy, the predomi- 
nant action of the Ca is more desirable. In addition, galvanization of the 
sympathetic is sanctioned both by experience and by anatomical and phy- 
siological considerations Large electrodes, feeble currents, short sittings 
(not more than two to five minutes) are recommended. 

In detail, then, the applications should be made as follows : firsts trans- 
verse passage of the current through the temples with a variable direction 
of the current, in order to reach the optic nerve within the orbit ; then 
longitudinal conduction from the neck to the closed lids (when neuritis 
predominates, the An chiefly on the eye, the Ca for a short time and sta- 



S 1 2 BLE0TRO-THERAPEUTI08. 

bile ; after atrophy has occurred, the Ca chiefly on the eye, after the 
cation of the An, stabile and moderately labile). Finally, galyanizafcioii oi 
the sympathetic according to the ordinary methods. 

Numerous observations prove, even at the present time, that decided 
benefits are obtained by this method. It is often found that the results 
are much better with regard to vision than the ophthalmoscopic appear- 
ances ; the most exquisite white atrophy may be present, although vision 
is tolerably fair. 



The results of electrical, as of other treatment are much less enooorag- 
ing in primary atrophy of the optic nerve, in which an inflammatory initial 
stage is not demonsti*able, but we have to deal from the start with a de- 
generation of the nerve. These are the gravest forms of optic nerve dis- 
ease, and only in very exceptional cases does a stand-still or regeneration 
occur ; however, treatment is not entirely useless and many observations 
make it our duty not to weary in our therapeutic endeavors in this field. 

This is especially true of optic atrophy in locomotor ataxia. It is ex- 
tremely frequent and important, because it often occurs early in the his- 
tory of this disease and many years may elapse before the development of 
other symptoma But this is not often the case, and since we have learned 
recently to recognize the earliest beginnings of ataxia, we will be able not 
infrequently to attach the proper pathological significance to the affection 
of the optic nerve from the presence of lancinating pains, reflex rigidity 
of the pupils, slight analgesia and esx>ecially the absence of the tendon re- 
flexea The disease manifests itself by diminution of the power of sight 
and the sense of color, contraction of the field of vision, and progressive 
amblyopia with the characteristic ophthalmoscopic appearances. 

It goes without saying that it is important to treat the veiy onset of 
the disease, as then alone is there any hope of maintaining the power of 
vision. But even then the results are very slight or entirely negative, and 
I have repeatedly seen the affection progress uninterruptedly from the 
very beginning to complete amaurosis. 

Nevertheless, there are a few cases which teach us that a stand-still or 
even more or less considerable improvement may be effected — ^and this 
also holds true of the coincident affection of the posterior columns of the 
spinal cord. I have treated a case of this character, of which, unfortu- 
nately, I do not possess any accurate notes. The patient was an officer, 
aged forty-six years, who had suffered for twelve years from the initial 
symptoms of tabes, and for two and a half years from atrophy of the optic 
nerves with considerable limitation of the field of vision in both eyea 
Galvanic treatment for a month produced considerable enlargement of 
the field of vision ; central vision had also improved in both eyes. 

The method of treatment is the same as that described above for 



SPECIAL KLECTROTHERAPEUnCS. 313 

iieuritic atrophy. But it is important in such cases to treat the spinal cord 
at the same time. 

The results in the not very infrequent so-called genuine atrophy of the 
optic nerve are somewhat less imlavorable. It occurs from unknown 
causes without any demonstrable connection with spinal or cerebral 
diseases, and is entirely analogous to the ** white optic atrophy " of ataxia 
in the functional disturbance and the ophthalmoscopic appearances. Some 
Tery favorable results of galyanio treatment in this form have been 
reported. 

144. Observation by Driver, Atrophy of the optic nerves. — ^A teacher, 
aged twenty-four years. Eye trouble for years ; amblyopic ; treated 
in various ways without success. Examination shows exquisite atrophy 
of both optic nerves with superficial excavation ; vessels extremely narrow ; 
nystagmus. With right eye sees finger at four feet, with left eye at 
three feet. Contra<3tion of field of vision ; Daltonism. Treatment for 
three weeks with injections of strychnine ; stand-still. Then galvanic 
treatment ; at end of two months patient counts fingers at twenty feet 
Treatment continued at home ; a year later reads Sn. No. 8 and recognizes 
all colons. Ophthalmoscopic appearances distinctly improved ; vessels 
larger. 

145. Observation by Driver. Beginning atrophy of the optic nerves. — A 
woman, aged forty-five years. Left amaurosis for considerable period ; 
recently noticed mist in front of right eye ; otherwise healthy. C^hthal- 
moscope : left eye, exquisite atrophy of optic nerve ; right eye, papilla 
somewhat whiter, vessels smaller than normaL y.=)^2-; field of vision 
and color sense normaL After galvanic treatment for three weeks, E. R, 
y.f {, mist disappeared, ophthalmoscopic appearances normal ; L. E., 
finger visible at two feet above and to the outside. Belapse at end of 
half a year. R E., mist again present, y.={^. Complete recovery after 
galvanic treatment for twelve daya 

146. Personal observation. Beginning atrophy of the optic nerves. — ^A 
man, aged forty-eight years. A drinker, suffering for eight months from 
diminution of power of vision, and frequent headaches. B. E., Y =y\;^ ; L. 
R, V=/(^. Binocular, J. No. 13 at seven inches. Normal tension of 
eyeballs, reaction of pupils normal ; refracting media clear. Papill» 
brighter than normal, not sharply defined ; vessels quite well filled ; field 
of vision and color sense normal. Galvanic treatment : 8 to 10 elements 
transversely through the temples and mastoid processes ; also from the neck 
to the eyelids, with variable direction of the current. Considerable im- 
provement in a few days ; head freer, pain disappeared, sight considerably 
better. After two weeks' treatment, examination shows : B. R, V.=i^ ; L. 
R, V. = ,^ ; binocular, J. No. 6. 

147. Observation by Dor. ]Vhite atrophy of the optic nerves. — A lady. 
Dnable to walk alone ; with great difficulty sees a few letters of Sn. LXX. 
at very short distance ; suffering for two years, first in right, then in 
left eye. White atrophy of both optic nerves. Frequent headache. 
Artifioal leeches and iodide of potassium produced improvement, so that 
she could read Sn. XX. ; then stand-still. Then application of faradic 
current ; in a week could read Sn. XV., in two weeks a letter of YHI., in 
three weeks of VL ; no further improvement. Patient returned at end of 



314 ELECTRO-THERAPEUTICS. 

seTen years ; slight relapse, but only to xx' Application of galvaaie 
current (October 6, 1871). October 28th, ^ ; patient then diacontmiied 
treatment, but improvement remained permanent. 

148. Observation by Dor. White atrophy of the right optic nerve. — A 
man, aged forty-six yeara Bight eye alfected for six weeks ; shows distinct 
white atrophy. V.=^J* very narrow field of vision. Qalvanic treatment 
In a week, y.=^, but field of vision distinctly enlarged ; in two weeks 
y.=: ^; field of vision again enlarged. Pfttient then continued the treat- 
ment at home, and writes that sight improved to such an extent that be 
finally discontinued treatment. 

These cases prove that the galvanic current j>08sesses a considerable 
curative power in those otherwise hopeless diseases of the optic nerve, 
which are manifested in the form of so-called white atrophy. From a 
considerable number of observations. Dor concludes that at least forfy to 
fifty per cent, of these cases may be really and notably improved. 

The method of treatment is the same as that which I have described 
above for secondary atrophy. As the duration of the process increases, an 
increasingly intense action of the Ca may be recommended. 

The electrical current also appears to possess a favorable influence in 
amblyopia and amaurosis without anatomical lesion. But different authors 
express very different opinions. Driver has seen scarcely any good 
results, while Boucheron, Secondi, Arcoleo, Seely, and others report 
favorably. 

We have to deal here with amblyopias from nicotine, alcohol, and lead 
poisoning, spontaneous and traumatic aniesthesia of the retina, hysterical 
amaurosis and amblyopia, amblyopia ex anopsia, and hemeralopia. 

149. Observation by Boucheron. Cerebral scotoma. — ^A man upon waking 
in the morning noticed a disturbance of vision in the left eye, which has 
since increased. Central scotoma ; can read J. No. 19. Ophthalmoacopic 
appearances negative. On the eighth day, application of a feeble perma- 
nent galvanic current, 2 elements Trouv4 for six hours ; J. No. 8 can then 
be read. Daily repetition of the application ; in four days, J. No. 1 can 
be read at 15 centimetres. Complete recovery. 

150. Observation by Bouclieron. Convergent strabismus ; marked ambly- 
opia of one eye, —A boy, aged seventeen years. Admitted January, 1875, 
with marked convergent strabismus and nystagmus ; is operated upon on 
both sides with good results. February, 1875, marked amUyopia of left 
eye still present ; with difficulty reads Sn. L. at 10 eentimetre& Applica- 
tion of feeble continuous current from 2 Trouv6 elements. An on the fore^ 
head, Ca on the neck ; during the entire night and sometimes a few hours 
during the day. In ten days, ^tient reads Sn. No. XXX. ; a week later. 
No. ^.; four days later, No. XV. Treatment discontinued until Mardi 
2d, then resumed' until March 8th, when he could read No. XIL and even 
No. X. 

151. Observation by Secondi. Traumatic anaesthesia of the retina. — ^A 
girl, aged sixteen years. Suffered a contusion of the eve ; no lesion, ex- 
cept an ecchymosis of the bulbar conjunctiva. Y. ^. Sight had diminiahed 



SPECIAL BLBCTBO-THEBAPEUnOS. 315 

at onoe after the acddeni The pupil is less mobile than on the healthj 
side. Gkdvanio treatment : Ca labile to the lids, An to the neoL Becoverj 
after three sittings. 

Arooleo reports yery favorable results in hemeralopia He dis- 
tinguishes two forms, an organic form, with visible anatomical changes^ 
and a functional one ; the electrical current is especially useful in the lat- 
ter, the results being '* so to speak unfailing.*' Considerable improvement 
also occurs in some organic forms. He employs the faradic current alone, 
the Ca to the closed lids, the An to the neck for five to ten minutes. Re- 
covery sometimes foUows a single sitting, and there is usually improve- 
ment^ at leasts after two to four sittings. 



JBismianopsia^ which has been made recently the subject of interesting 
physiologicsJ and pathological discussions, may also become an object of 
electrical treatment I have under observation, at the present time, a case 
which developed coincidentally with a left hemiplegia, in which galvanic 
examination reveals in both eyes a field of light which represents but half 
of a circle and corresponds accurately to the shape of the remaining por- 
tion of the field of vision. As hemianopsia, at least in the homonymous 
lateral forms, is never due to a disease of the eye but always to an affeo* 
tion of the optic tract or brain, direct applications to the eye should be 
omitted, as a rule, and the treatment confined to the primary affection 
cording to well-known methods. 



Finally, it remains for me to say a few words concerning (^ecUons of 
<Ae ocular mttades and their nerves. The most frequent and important 
ones, viz., the paralyses, have been discussed with sufficient detail in a pre- 
vious lecture (Lecture XXTT., p. 198). I will here say a few words vnth 
regard to those paretic conditions of individual muscles which belong al- 
most exclusively in the domain of the oculist— above all, the so frequent 
muscular asthenopia which is due to insufficiency of the internal recti and 
in which very favorable results have been secured by means of the gal- 
vanic current. The method of application should be that recommended 
on page 198. 

Electricity has also been recommended in accommodative asthenopia and 
in mydriasis, but recovery is often very long in making its appearance. 

In disturbances of the pupillary reflexes, the galvanic current has been 
entirely useless hitherto in my hands. 

Very little can be said concerning spasmodic affections of the eye. 
Blepharospasm has been discussed previously on page 270 ; the galvanic 
current (stabile from the mastoid process to the eye, one to two minutes 
daily) has been employed successfully in acquired nystagmus by Soetlin 
and Nieden. Very little can be done in congenital nystagmus, and in 
that due to multiple sclerosis, hereditary ataxia, eta 



LECTURE XXXm. 

Diaaaaes of the Auditory Apparatoa — Introdaction — Dryneas of the Andltocy 

Opadties of the Membrane — Diaeasee of the Auditory Nervona Apparmtns : Ker- 
Toas Tinnitaa Aoritun ; Ita Relationa to Oalyanio Beaotion ; Bleotro-diagnoaia ; 
Therapeutic Indioationa; Determination of the Method of Treatment; Caaaa; 
Prindplea of Treatment ; Special Prooedurea in Indiyidual Caaes ; General Bnlea 
and Technical Bemarka ; Resulta — Nervoua Deafneaa ; Caaea; Method of Treat- 
ment — Deaf-mntiam~Menidre*a Diaeaae — ^Neuroeea of the Guatatory Neirea; 
Agenaia — Neuroeea of the Olfactory Nerrea : Anoamia and ita Treatment. 

^ I NOW arriye at the consideration of the auditory apparatus. Numeir- 
ous attempts have been made for man j years to relieve patients suffering 
&om ear troubles by means of electrical currents. Many of these at- 
tempts were not fruitless, but the condition of otology as well as of elec- 
tro therapeutics did not admit of exact scientific progress in this depart- 
ment 

This dates from Brenner's admirable investigations, which have se- 
cured for the galvanic current an important domain in the treatment of 
diseases of this organ. 

Nervous diseases of the ear alone have been subjected hitherto to elec- 
trical treatment But such affections are frequent; the labyrinth and 
auditory nerve are primarily affected not infrequently, and still more com- 
monly disturbances in the nervous auditory apparatus complicate diseases 
of the conducting apparatus. That annoying and distressing symptom, 
tinnitus aurium, is especially common, and is in many instances of purely 
nervous origin, in others not at all, or can be attributed only in part to a 
nervous disorder. Every expert knows how difficult it often is to remove 
this symptom, and how powerless otology is, especiaily its favorite me- 
chanical methods of treatment In these very forms of disease, however, 
the electrical current, especially galvanism, is very often curative and not 
infrequently diminishes the accompanying deafness with the relief of the 
subjective noises. Not uncommonly the results in this field are really 
brilliant, after all other methods of treatment have failed. Nor do they 
depend merely on chance, but are obtained upon the basis of methodical 
diagnostic examination and the consequent scientific determination of the 
therapeutic indications. This is proven by nimierous incontrovertible 
facts. 



SPECIAL BLEOTBO-THBRAPBUnC& 317 

In addition to nervous ear diseases, a few other pathological conditions 
of the organ may be successfully subjected to the influence of electrical 
onrrent& 

1. Abnormal dryness of the external auditory canal, associated with an 
annoying feeUng of coldness, heaviness, and lifelessness of the entire ear, 
produced by deficient secretion of cerumen, occurs in many chronic ear 
diseases. The action of galvanic currents, especially when introduced by 
means of a suitable electrode into the auditory canal filled with water, 
usually removes this symptom very rapidly and effectually, according to 
Brenner's and Hagen's experience ; probably by acting upon the blood- 
Tessels and secreting glands. The auditory canal again becomes flexible 
and moist, the secretion of cerumen returns, and the normal sensation of 
these parts is restored. 

2. Opacities of the tympanum, which, as is well known, are extremely 
common, always depend upon the deposit of pathological products, 
although these may vary greatly in chamcter. The frequently observed 
fact that an intense congestive condition of the tympanum may be pro- 
duced by the action of galvanic currents upon the ear (and is character- 
ized by marked injection in the region of the handle of the hammer) led 
Brenner to make use of this phenomenon for the absorption of certain 
opacities of the tympanum. This idea was confirmed by experience, and 
Hagen has reported a series of similar observationa The method con- 
sists in the introduction of an electrode into the external auditory canal 
(filled with water) and the stabile application of galvanic currents of a 
variable direction, so that both poles act alternately. As a m fitter of 
course, great patience is required in this method, especially if the opaci- 
ties are very old. In a number of cases, however, Hagen has seen the 
opacity disappear or diminish very considerably after twelve to twenty sit- 
tings, and Hedinger has had similar results. 

3. Diseases of the auditory nervous apparatus itsdf — By fax the most 
important, from a practical {>oint of view, are the morbid subjective noises 
in the ear or nervous tinnitus aurium. 

This is very common, extremely annoying and depressing to the pa- 
tient, disturbs sleep and temper, is associated with disagreeable sensa- 
tions in the head, diminishes the desire and capacity for work, and is felt 
usually much more severely by the patient than the difficulty in hearing 
or deafness ordinarily associated with it. This condition is very often 
inaccessible to all otological treatment, so that there is no doubt of its 
great practical importance, and we must therefore regard it vnth a double 
satisfaction that a very important auxiliary measure against this obstinate 
and serious disease has been found in the galvanic current 

I have already laid sufficient stress upon the great importance of the 
galvanic current for the more accurate diagnosis of these subjective audi- 
tory sensations (Lecture XL, p. 96). It was then found that the results 
of galvanic examination differ greatly in cases of subjective noises in the . 
ear. The most common reaction is simple galvanic hyx>eraesthesia, in- 
creased not infrequently to the ''paradox reaction ;" or hypersesthesia is 



318 ELBCTBO-THEBAPEUnOS. 

manifested with Tarious anomaliea of the normal formula up to its oom* 
plete reversal, or simple anom^Ues of the normal formula without hyper- 
ses&esia, eta But there are numerous cases in which galvanic examina- 
tion shows no anomalies in the reaction of the auditoiy nerve. On the 
other hand, it has been proven that the galvanic current not infrequently 
exercises a direct modifying influence upon the subjective noises; that 
in a series of cases the tinnitus is diminished bj the action of the current, 
or entirely stopped, at least by certain factors of the stimulus, while it is 
increased by others. As a rule. An CI and An D, to a slighter extent 
da O, exercise this inhibitory influence upon the tinnitus (as in almost all 
cases of simple galvanic hypera^sthesia). But it sometimes happens that 
Oa CI and Ca D lessen the noise, especially in hyperaesthesia with reversal 
of the normal formula, but occasionally when the formula is qualitatively 
normal. In another series of cases the tinnitus is not affected in any 
manner by the current, and finally, there are certain mixed forms with 
two or more noises, in which one or more of these noises may be lessened 
or abolished by the current (usually by An D), while the other is entirely 
uninfluenced. This indicates a difference in the mode of development of 
these noise& 

The most important point in practice is to determine whether the af- 
fection is of nervous origin or not 

If there are distinct anomalies in the galvanic excitability of the audi- 
tory nervous apparatus, we may at least suspect that the affection is due 
entirely or in part to a disease of the nerve. This is rendered extremely 
probable if the tinnitus can be distinctly modified by the galvanic current, 
especially if it is lessened by An D. 

On the other hand, its nervous origin is very improbable when no 
anomaly can be foimd in the galvanic excitabihty of the auditory appara- 
tus, or the galvanic ciurent produces no modification of the tinnitus. 
However, its nervous origin is not excluded absolutely thereby, and 
though such cases present very little chance of therapeutic success, the 
therapeutic experiment alone can decide positively with regard to its cura- 
bility or incurability by means of the galvanic current. 

The determination of the method of treatment depends solely upon 
the formula of galvanic reaction, with reference to the ameliorating influ- 
ence of the current upon the tinnitus. At least, this statement is true, 
with scarcely any exception, of the simple and uncomplicated cases of 
simple hyperaesthesia with tinnitus aurium. It is perhaps premature to 
regard the restoration of the normal formula as the direct object of treat- 
ment ; the immediate effect of the current upon the noise itself must 
always be taken into consideration. 

152. Observation by Brenner, Simple galvanic hypercesihesia with <tnnt- 
iu8 aurium, — A student, aged twenty-three years. Suffering from defect- 



SPECIAL ELECTBO-THEBAPBUnOS. 819 

ire hearing, and constant, extremely seyere tinnitus in both ears as the 
resolt of long-standing catarrh of the middle ear. Marked mental depres- 
sion, interference with study. Watch heard at one inch on left side, two 
inches on right ; the membranes thickened, very opaque ; light spot yery 
small on right side, absent on left ; Eustachian tubes pervious on both 
sides ; repeated treatment useless. 

Successful electrical treatment of tinnitus a few months ago ; relapse 
at present time in consequence of excessive mental work and excitement 
Oalvanic examination with very slight strength of current showed upon 
both sides : 

Ga CI, violent ringing. 

Ca D, continued ringing. 

Ca O, tinnitus stops for a little while, then gradually grows stronger. 

An C9, tinnitus disappears suddenly and completely. 

An D, tinnitus remains absent. 

An O, tinnitus returns with increased severity. 

For purposes of treatmeut, each ear is armed with the An (Ga in the 
hand), the Unnitus abolished by An D with a relatively strong current^ the 
strength of current then gradually diminished with the aid of the rheostat, 
and finally the circuit opened by withdrawing the Ga slowly from the 
hand ; this was followed by complete cessation of the tinnitus. Perma- 
nent abolition of tinnitus after two more sittings ; watch heard at four 
inches on left, six inches on right side. 

163. Ohftervation by Brenner, Tinnitus aurium after administration of 
quinine ; simple galvanic hypercesthesia ; recovery, — ^A woman, aged thirty- 
three years. Had taken laxge doses of quinine for three weeks ; then ac- 
quired an extremely annoying, incessant tinnitus auriimi, which remained 
unchanged for past three months; moderate diminution of audition on 
both sides. Otological examination furnished negative results. 

Cbdvanio examination showed moderate simple hypersesthesia, and 
complete cessation of tinnitus at An Gl and An D. Treated with An D, 
and gradual diminution of current After the first sitting, tinnitus re- 
mained absent for two hours ; complete recovery after the fifteenth sitting ; 
the head felt free, disposition cheerful, impairment of hearing had disap- 
peared. 

154. Personal observation. Impairment of hearing and tinnitus aurium ; 
bilateral hypercBsthesia of the acoustic nerve / paresis of the right abducens 
nerve, — ^A man, aged fifty-nine yeara Impairment of hearing and tinnitus 
aurium for six months, constantly on both sides ; the noise sounds like 
ringing of bells or the boiling of water. Increasing vertigo for a month ; 
diplopia for three weeks. Status on January 7, 1870 : paresis of right 
abducens ; chronic catarrh of middle ear ; diffuse opacity of both mem- 
bronse with diminution of light spot ; Eustachian tubes pervious ; feeble 
conduction through the bones, better on right side than on left. Watch 
heard at eight inches on right side, five inches on left ; after catheteriza- 
tion, at twelve inches on right, nine inches on left. 

Galvanic examination shows simple hypersesthesia in both ears; the 
noise disappears entirely during An D. Treatment consists of vigorous 
application of An D to each ear, with gradual diminution of current (also 
treatment of abducens paralysis). After ten sittings, abducens paresis very 
much better; tinnitus aurium decidedly less, and only occurs at times. 
Slow progress of improvement ; after forty-four sittings, patient was dia- 
-eharged in following condition: diplopia almost entirely disappeared; 



320 ELECTBO-THSRAPEUnOS. 

tinnitus annum absent, except that it oocaaionally appears on left 
hearing slightly improved. 

156. Observation by Hagen. TinnituB aurium and impairment of hear- 
ing ; simple hypercesthesia of both acoustic nerves. — A man, aged forty-twa 
Tinnitus aurium and impairment of hearing six years ago after a cold, 
gradually growing worse. Bight ear : membrane opaque, light spot ab- 
sent; hears watch at nine inchea Left ear: membrane shows grayish 
white radiating streaks, light spot absent ; hears watch at eleTen inches. 
Tuning-fork heard equally well on both sides ; pharyngeal catarrh. Tubes 
pervious. After continued otological treatment, could hear on right side 
at one foot, on left at one foot seven inches, but the subjective auditory 
sensations not improved. 

Ghdvanic examination shows simple hyperaesthesia of both ears. Treat- 
ment with An D, and gradual diminution of the current. After sixteen 
sittings, tinnitus aurium entirely and permanently relieved ; hears at four 
feet on right, and two feet on left side. Opacities of membranes gone, 
light spots distinctly visible. 

156. Observation by Hagen, Tinnitus aurium. Simple hyperossthesia 
of the. acoustic nerve, — A woman, aged fifty-nine years. Suffering from 
threefold subjective auditory sensations in right ear, viz. : singing, whist- 
ling, and roaring ; very hard of hearing in right side ; membrana tympani 
very yellow, opaque, without light spot Catheterism, nir douche, and 
strychnine injections uselesa Galvanic current shows simple hyperses- 
thesia. The roaring and whistling disappear during An D, singing unaf- 
fected. After a few sittings (An D) the roaring and whistling disappeared 
permanently but the singing noise was unchanged. 

157. Observation by Hagen, Bilateral tinnitus aurium and impairment 
of hearing ; simple hypercesthesia, — ^A man, aged thirty-four yeara Suffer- 
ing from tinnitus auiium and impairment of hearing on right side for 
three years, on left for a year and a half. Bight ear : moderate opacity of 
membrane, light spot duU, long arm of anvil not visibla Left ear : mem- 
brane grayish white in posterior quadrant, light spot dull, manubrium 
very short Watch not heard on either side ; very loud talking heard at 
one foot. Conduction through bones better on right side than left ; tubes 
pervious. Symptoms not improved by catheterism. Galvanic examina- 
tion shows marked simple hypera^sthesia on both sidea Application of 
An D and gradual diminution of current forthwith relieved the tinnitus 
in both ears so completely that a second sitting was imnecessaiy ; the re- 
covery was permanent (patient seen after seveiBl weeks). 

158. Observation by Brenner, Chronic buzzing in the head and HnnUus 
aurium with impairment of hearing / hyperassthesia until paradox formidcL 
— A physician, aged fifty years, suffering since childhood from great diffi- 
culty of hearing and distressing subjective auditory sensationa Watch 
heard on right side upon applying it to the ear, not at all on left side ; 
tubes pervious, membranes very cloudy, etc. In addition to the tinnitus 
aurium the patient also recognizes a deeper noise of a different character 
which he locates in the occiput ; upon falling asleep, he hears detonations 
which are followed by twitchings. Galvanic examination shows enormous 
hyper.'Fsthesia of both acoustics with paradox reaction of the unarmed ear. 
During An D, complete cessation of the buzzing in the head, but tinni- 
tus aurium unaffected. Patient was treated with galvanism on a num- 
ber of occasions for several months, with very favorable resulta The 
buzzing in the head constantly diminished, the detonations upon blling 



SPECIAL BLB0TROTHSBAPEUTI08. 321 

aaleep gradually disappeared, hearing improyed, the head felt free, dis- 
position more cheerful, but the tinnitus aurium remained. 

159. Observation by Hagen. Impairment of hearing and tinnitus aur 
rium; hypercesthesia with reversal of the normal formula. — A girl, aged 
seventeen year& Hard of hearing for three months, and subjective noises 
(roaring, singing, ringing of bells) on both sides, more marked on left 
No cerumen on either side ; membranes opaque, without light spot ; 
tubes pervious ; hears watch at four inches on right side, one inch on 
left. Otological treatment for several weeks proved useless. Galvanic 
examination showed following formula : 

Ca CI, 

Ca D, 

Ca O, feeble hissing. 

An CI, loud hissing. 

An D, continued hissing. 

AnO, 

Ca D produced immediate diminution of the subjective noisea Treat- 
ment with Ca D and gradual diminution of current After the eighth 
sitting the ringing alone returned at times ; after the seventeenth sitting, 
this also remained permanently absent ; hearing somewhat improved. 
The Ca O reaction in the galvanic formula disappeared, but the latter 
did not return to the normal. Recovery permanent. 

160. Observation by Moos, Impairment of hearing and tinnitus aurium 
after cerebrospinal meningitis, — A man, aged twenty-one yeara Had cere- 
brospinal meninigitis in 1866, followed by complete deafness ; later some 
improvement on left side, none on right ; loud bilateral subjective noises. 
Summer of 1867, complete deafness of right ear ; on left side, watch heard 
at three feet, but complete deafness for deep tones. Complete integrity 
of the mechanism of the auditory apparatus. Various methods of treat- 
ment useless. In left ear, formula of simple hypemesthesia ; subjective 
noises diminished by An D ; after first sitting, watch heard at six feet In 
right ear, loud hissings at Ca CI, but no improvement by further treat- 
ment On the left side, could understand speech at eighteen paces (be- 
fore treatment at two paces) after twenty-two sittings and the subjecave 
noises were considerably moderated. 

> 

The method of treatment which should be adopted can be readily de- 
termined from these cases. It may be laid down as a general principle 
that those factors of the stimulus, which diminish or abolish the subjec- 
tive noise, should be applied with the greatest possible intensity and 
duration, and, on the other hand, those which increase the tinnitus should 
be diminished as much as possible or entirely avoided (by gradually di- 
minishing or increasing the strength of the current). 

In tinnitus aurium associated with simple hypersesthesia, which is 

diminished by AnD, close the circuit with the An, in full strength, and 

then gradually diminish the current after a sufficiently long application of 

An D, in such a manner that *' opening" stimulation is avoided. Not 

infrequently this must be done very slowly and cautiously, and a greater 

strength of current, must often be resorted to again, and the duration of 

the sitting prolonged, before an absolutely non-irritant diminution of the 
21 



32 2 ELECTRO-THER APEUnCS. 

current is rendered possible. If the action of the An D is to be increased 
by a preliminary change of polarity, dose the circuit at the Ca, with a 
TBinimnro strength of current, then gradually increase its strength, and 
finally change rapidly to An D. 

But if the hyperesthesia is so great that the paradox reaction is pres- 
ent, the proper method consists in arming both ears with one bifurcated 
electrode and then carrying on the treatment in the manner described 
above. This procedure may also be adopted in bilateral simple hyperaes- 
thesia of a moderate grade. 

When tinnitus aurium is associated with hyperaesthesia and reversal of 
the normal formula, you will often find that the tinnitus is diminished by 
the action of Ca D and increased by An CI and An D. In this event, 
you must increase and prolong the action of Ca CI and Ca D, avoid Ca O 
by gradual diminution of the current, and that of An CI by gradual in- 
orease of the current. In other respects the treatment is the same as in 
simple hyperesthesia. 

The conditions become more difficult when other anomalies of the 
normal formula, with or without hypersesthesia, are present. It must be 
left, then, in great part to the tact of the electro^therapeutist to determine 
what method will prove successful in the individual case. The leading 
principle should be, however, that the method of treatment depends upon 
the fact whether the tinnitus is diminished by An D or Ca D. 

Under all circumstances, however, you should not be deterred by 
theoretical considerations from one or another method of treatment until 
all available methods have been exhausted. This will hold true also of 
all the rarer anomalies of reaction hitherto unmentioned, of the entirely 
irregular forms associated with tinnitus aurium, and also of those cases in 
which galvanic examination furnishes no distinct resulta In these not 
infrequent cases you may try any method of electrical treatment, however 
hopeless it may seem, and test it systematically for some time. I have 
repeatedly seen considerable improvement effected in this manner. In such 
patients I should consider it justifiable to employ even the faradic current 

In the majority of cases these methods of treatment require great ex- 
actness of manipulation, reliable apparatus and suitable application, to- 
gether with an accurate knowledge of all the data in question and a clear 
conception of the object to be effected. It is best to employ the external 
method of application {vide page 65), the indifferent electrode being placed 
in the opposite hand. Good fixation of the electrodes is necessary ; the 
polarity changer and all other parts of the apparatus must be so arranged 
that unwished for interruptions of the current are prevented ; special care 
should be paid to the gradual increase and diminution of the current. 
Diminution of the number of elements alternating with diminution of the 
resistance of the rheostat (in the auxiliary circuit), long-continued applica- 
^n of the lower strengths of the current before it is still further weakened. 



8PB0IAL SLEOTBO-THBBAPBUnO& 838 

finally the passage of the aural electrode over the sca^ are the methods 
by which the current can be gradually diminished. 

The sittings must often be quite long — from fiye to tweniy minutes ; 
their repetition depends upon circumstances. 

The results of the galvanic treatment of tinnitus aurium vary greatly, 
sometimes very brilliant and rapid, sometimes very gradual, often entirely 
absent. The proportion of successes to failures cannot be determined at 
the present time. In the most favorable forms (simple hyperaesthesia with 
a certain amount of diminution of the tinnitus by An D) the tinnitus 
usnaUy disappears after the sitting, for one-quarter to one-half hour, or for 
several hours, perhaps until the next day. It rarely disappears permanently 
after a single sitting, though this has happened {vide Observation 157). 
As a rule, it returns gradually with increasing severity after the period 
mentioned, and is again made to disappear (this time for a longer period) 
by the next galvanic sitting. And thus recovery is gradually produced. 
The more rapidly the tinnitus returns after the first sitting, and the more it 
approaches its former intensity and character, the more slowly will recov- 
ery ensue, and vice versa. From the observations made hitherto, all forms 
of tinnitus appear to be curable which can be made to disappear com- 
pletely by An D. In the less favorable cases a long time often elapses be- 
fore a good result is secured, and not infrequently various methods of 
treatment must be employed in order to attain our end& I have observed 
repeatedly that tinnitus aurium which was inaccessible to the current at 
first was improved and cured by galvanism after an intermission of half a 
year to a year in the treatment 



The previous observations show that nervotis deepness is improved very 
often by the galvanic current and by the same manipulations which pro- 
duce disappearance of tinnitus aurium {vide Observations 152, 155, 160). 
But cases of deafness also occur in which tinnitus aurium is not present and 
in which the nervous origin is rendered at least very probable by the absence 
of demonstrable affections of the ear, the presence of anomalous formulsB 
of galvanic reaction and of various nervous disturbances. 

161. Observation by Brermer, Deafness iinthotU demonstrable anatomical 
changes; anomalous galvanic reaction, — A man, aged twenty-three. Suffer- 
ing for two years from deafness ; examination of ear negative. Watch heard 
at five inches on right side, three inches on left ; conversation at three feet, 
whisper only in immediate neighborhood. Formula of galvanic reaction : 

Ca CI, loud ringing. 

Ca D, ringing lessened. 

CaO, ) 

An 01, >• sensation of ringing of a different timbre. 

AnD, ) 

An O, ringing lessened. 



3 24 ELEOTRO-THEBAPEUnOS. 

The object of treatment was the avoidance of the pathological An CI 
tion by gradual increase of the current, the increase of An O reaction by 
prolonged duration of the current, the increase of Ca CI reaction by change 
of polarity from An to Ca, and the avoidance of Ca O reaction by gradual 
diminution of the current 

After treatment for two months : watch at twelve inches on right side, 
seven inches on left ; conversation at seven feet, whisper at two feet 

162. ObservcUion by Bremier. Deafneist with anatomical changes ; torpor 
of the acoustic nerve. — A woman, aged fifty year& Suffering for seventeen 
years from increasing deafness with severe tinnitus aurium and mental de> 
pression produced hereby ; watch cannot be heard at all ; membran» 
tympani slightly cloudy with normal light spot ; hammer very prominent. 
Long-continued treatment relieved the tinnitus and improved hearing so 
that watch could be heard at forty-six inches on right side, two and a 
half inches on left side. Right auditory nerve presented an almost normal 
formula of galvanic reaction, the left one all the signs of torpid reaction 
(page 101). Left ear treated with galvanic current, with change of polarilj 
from An to Ca. The result was : 

First sitting : hearing at 2^ inches 

Second sitting : hearing at 3| inches 

Sixth sitting : hearing at 6^ mches 

Ninth sitting : hearing at 11 inches 

Tenth sitting : hearing at 15 inches. 
The signs of diminished excitability decreased, and Ca D and An O 
actions made their appearance. Treatment discontinued. 



A few words may be devoted to a consideration of Meniere's 
since its nervous origin is abundantly proven by the sudden deafness, the 
not infrequent tinnitus aurium associated with violent vertigo and vomiting, 
the absence of changes in the external and middle ear, and the results of 
examination of the auditory nerve itself. Whether the affection is due to a 
hemorrhage or inflammation of the labyrinth has not been decided posi- 
tively. 

This almost hopeless disease may be treated by the galvanic current^ 
the method being based upon the formula of galvanic reaction which may 
be present or upon the rules which hold good generally with regard to 
the treatment of intracranial anatomical processes. 



Neubosxs of thb Gustatohv Nebvbs 

are very rarely the object of special electrical treatment The only dis- 
turbance which comes into question occasionally is the paralysis of taste 
or ageusis. It is scarcely ever found isolated, but is very often a symptom 
of the most varied nervous diseases, as in lesions of the trigeminus at the 
base of the skuU, lesions of the chorda tympani in the middle ear, in rheu- 
matic and traumatic facial paralysis, in peripheral lesions of the lingualis, 
or in diseases of the glosso-pharyngeus ; furthermore, in certain cerebral 



SPECIAL BLECTBO-THBBAPBUnOS. 825 

affections, in hemiansesthesia (associated with an affisction of the other 
special senses), with especial frequency in hysterical hemianaesthesia. 

You are aware that all or the majority of these lesions may be treated 
with the electrical current Above aU, treatment should be directed to 
the primary affection, according to the well-known methods, which may 
vary greatly in individual cases (galvanization transversely and longitud- 
inally through the skull, etc.). 

The disturbance of taste ordinarily disappears rapidly, as, for example, 
in rheumatic facial paralysis, provided, of course, that the lesion is cur- 
able. As a rule it will be unnecessary to apply treatment directly against 
the ageusis, but the latter sometimes persists longer than the primary dis- 
ease or remains permanently. 

If direct treatment is considered advisable, the nerve of taste may be 
excited directly in the buccal caviiy or the tongue (preferably with the 
galvanic current). The mucous membrane which is affected is stroked 
with a small sponge electrode (pharyngeal electrode, vide page 221) or 
with Neumann^s pair of electrodes (consisting of olive-tipped sounds) for 
a couple of minutes with a strength of cmTent sufficient to produce dis- 
tinct gustatory sensations upon the normal half of the patient's tongue or 
upon your own tongue. 



NXUBOSBB OF THB QlPAOIOBT NeBVSB 

are much more infrequent and unimportant than gustatory neuroses, 
although they often produce a much more considerable disturbance of 
taste than the latter. 

Diminution of the sense of smell, or anosmia, alone has been the sub- 
ject of electro-therapeutic efforts. It is not very infrequently isolated 
(from diseases of the nose itself, lesions of the olfactory nerves from in- 
juries to the skull, degeneration of the nerves from senile processes, etc.), 
but is often combined with various other nervous disorders, which are 
dependent upon the primary affection (in cerebral tumors, gunshot 
wounds through the orbit, meningitis, cerebral hemorrhage, hysteria, 
etc.). With regard to the localization of the therapeutic measures it may 
be stated that anosmia of the left side is often associated with right hemi- 
plegia and aphasia ; that anosmia associated with hemianeesthesia and 
implication of the other senses indicates the internal capsule as the site of 
the lesion ; but that the site of cortical anosmia still remains to be defi- 
nitely located (probably in the parietal lobes). 

A few cases of successful electrical treatment of anosmia have been re- 
ported. Duchenne has seen good results from faradization of the nasal 
mucous membrane, especially in hysterical patients. In three cases of 
anosmia of one to ten years' standing (probably due to chronic coryza) 



826 BLEOTBO-THXBAPEUnO& 

treated by Baerwinkel, recovery ensaed in two cases after six sittingB^ 
and improTement in the third after six sittings. His method consii^;ed of 
galvanization with a weak current from the neck to the nasal mucous mem- 
brane, the catheter-shaped electrode being moved slowly across the latter, 
especially the posterior parts ; this produced various subjective ol&ctoiy 
sensations and profuse secretion. Fieber also derived benefit from the 
application of the galvanic current (olive-shaped electrodess in both noa- 
trils). During the galvanic treatment of a case of tinnitus aurium, Nef tel 
observed the restoration of the sense of smell which had been lost for 
twenty years. Beard also observed improvement of anosmia from external 
and internal galvanic treatment of the nose ; and Ferrier cured within 
a few weeks a traumatic anosmia of long years* standing by the galvanie 
eurrent (transversely through the zygomatic fossae or from the root of the 
nose to one of these fossae). 

There is no doubt^ therefore, that some cases of anosmia can be aami, 
by means of electricity. 



XL DISEASES OF THE ORGANS OF LOCOMO- 
TION. THE GLANDS, THE THORACIC VIS- 
CERA, AND THE DIGESTIVE APPARATUS. 



LECTURE XXXIV. 

Diaaaaci of the Ozgana of Locomotion : Mascolar Bheamatinn ; its Varieties and 
Character ; Yarions Methods of Treatment ; Resalte— Articular Affections ; In- 
troduction — Acute Inflammations of the Joints: Traumatic and Other Forms; 
Bhenmatic Polyarthritis ; Chronic Inflammations of the Joints : 1. Monoartien- 
lar Olixonic Articular Rheumatism ; 2. Polyarticular Chronic Articular Bhenraa^ 
tism; 8. Arthritis Deformans; 4. Stiffness and Ankylosis of the Joints — ^Dis- 
eases of the Glandular Oigans ; Tumors of the Lymphatic Glands— Scrofulas- 
Splenic Tumors — Diseases of the Thoracic Viscera — Nervous Asthma—Nervons 
Palpitation of the Heart— Debility and Irregularity of the Heart. 

In this seotion I shall discuss a series of diseases in which the electrical 
onrrent occasionally produces very notable curative efiect& They include 
various affections, partly nervous, partly non-nervous, to a certain extent 
of great practical importance and scientific and therapeutic interest, to 
some extent of subordinate significance, though always worthy of mention. 
I begin with 

Diseases of the Organs of Looomotion. 

The active organs of locomotion, the muscles, have engaged our atten- 
tion to such an extent that not much remains to be said in this con- 
nection. 

I shall refer only to a very frequent and painful affection, which is 
generally known under the term muscular rheumatism, and in which elec- 
trical treatment is attended usually with very favorable results. The 
affection occurs in various forms and in all possible muscles of the body, 
and is known preferably as myalgia. Rheumatism of the lumbar musdes 
is known as lumbago, of the neck muscles as torticollis or caput obstipum, 
of the chest muscles as pectoral myalgia or pleurodynia, etc. 

All these forms occur quite often, are attributed generally by the pa- 
tients to cold or a sudden over-exertion and strain of the muscles ; they 



J 



1 



328 ELBCTBO-TUEBAPEUnCS. 

are, under all circumstances, very painful and often yery obstinate, so that 
they sometimes resist all methods of treatment for months and yeara 

We are still entirely in the dark with regard to the nature of this affec- 
tion. It is assumed that in a part of the cases slight circulatory disturb- 
ances occur (congestion, temporary inflammation with serous and similar 
exudations), or, in another part of the cases, local solutions of continuity 
occur in the bundles of muscular fibres ; perhaps neuritic or neuralgic 
affections sometimes develop in the sensory fibres within the muscles, 
muscular sheaths or fascise ; and finally some forms constitute a transition 
to tonic spasm of the muscles or cramp, and may be termed rheumatic 
contracture. 

The first method of treatment is the application of the faradic brush to 
the integument over the painful muscles with a vigorous current for a few 
minutes, so that intense redness of the skin is produced ; sometimes the 
pains disappear at once as if blown away. 

Another method is vigorous faradization of the affected muscles them- 
selves, with strong currents, so that powerful contractions are produced. 
In the lumbar muscles medium electrodes should be employed, both being 
placed upon the muscle ; the current should be graduaUy increased and 
diminished several times during the sitting, which lasts from five to ten 
minutes. This procedure is quite annoying, because the contractions of 
the affected muscles are in themselves very painful ; but the pains subside 
usually after a short period of contraction. 

Ghdvanic applications are much milder and at least as effective, in some 
cases much more so than the preceding methods. This plan consists in 
the application of the An to the most painful point, while the Ca is placed 
opposite or upon an indifferent spot, or in succession upon several spots 
in a circle around the An. A stabile current of considerable strength is 
employed for a few minutes ; at the close of the sitting, a few interrup- 
tions and changes of polarity are made, so that vigorous contractions of 
the muscle ensue. This is usually followed forthwith by relief ; the same 
procedure may be immediately repeated once or twice (duration of entire 
sitting five to fifteen minutes) imtil the pain has wholly disappeared. 

Poore recommends the combination of a sort of gymnastics (vigorous 
contraction) of the affected muscles with this galvanic treatment 

The results of all these procedures are commonly very brilliant, and the 
relief of muscular rheumatism is one of the most grateful objects of elec- 
tro-therapeutics. Considerable relief is experienced usually at once after 
treatment, not infrequently complete disappearance of the pain and stiff- 
ness. This is true not alone of recent cases, but I have seen it occur when 
the affection had persisted obstinately for months. I have even seen im- 
mediate relief produced b}' the galvanic treatment in several cases of acute 
febrile myalgia, but two to ten more sittings are requisite, as a rule, to 
produce this result. 



SPlfiCIAL ELKCTBO-THERAPEUT1C8. 329 

Numerous attempts have been made to cure joint diseases by means of 
electricity, but the methods of treatment have not been systematically de- 
veloped hitherto. 

We have to deal chiefly with the various forms of articular inflamma- 
tions and it appears serviceable to divide them into acute and chronic 
form& 

Acute Inflammations of the Joints. 

While some reject entirely the employment of electricity in acute in- 
flammations of the joints, and a few reg^d it as useless or even injurious 
in all acute rheumatic inflammations, others believe that both the galvanic 
and the laradic currents are applicable and often very useful in the acute 
form& 

There appears to be no doubt that electriciiy is beneficial in acute 
traumatic inflammations of the joints, in subluxations and their sequelsB ; 
Bemak has obtained good results in these cases with the galvanic current, 
Weisflog with the faradic current 

The swelling, heat, and pain in the joints usually diminish rapidly after 
the sitting, their mobility increases and the regular continuance of treat- 
ment soon produces recovery. At the present time, however, this method 
has a formidable rival in skilfully performed massage. 

Very favorable results have also been obtained in spontaneous rheu- 
matic or symptomatic acute inflammations of the joints by Bemak and 
Weisflog. 

Bemak's method, which may be recommended strongly, consists in the 
passage of a quite strong, stabile galvanic current through the joint, with 
change of polariiy but predominant influence of the An, especially while 
the pain is still very great ; at the dose of the sitting a few interruptions 
are made and labile currents are passed through the adjacent muscles and 
along the neighboring vessels and lymphatics. The duration of the sit- 
ting is ten to twenty minutes. 

The method of faradic treatment practised by Weisflog, consists of the 
passage of a strong laradic current through the joint with large moist 
electrodes or by means of local electrical baths, several times daily for a 
shorter or longer period (fifteen minutes to one hour). Weisflog applies 
the current in this manner (the application being made by the patient; 
from six to ten times in the twenty-four hours, day and night, and reports 
very good results therefrom. This writer regards the faradic current as 
injurious in acute articular rheumatism. Bemak is inclined to attribute a 
very favorable influence to the galvanic current in acute febrile rheuma- 
tiam, both upon the local process as well as upon the fever and general 
dyscrasia so far as they are due to the local affection. He states that spe- 
ciaUy good results were obtained in the local disturbances, the pain, stiff- 
ness, muscular weakness, etc., left over after the cessation of the fever. 



330 SLEOTBO-THBRAPKUnCS. 

Not long ago Drosdoff reported some surprismg observations oonoeni- 
ing the action of the faradic current in acute articular rheumatism. He 
fotrnd that the sensitiyeness to the faradic current (moist electrodes) vss 
markedly diminished in the affected joints, and that faradization with a 
vigorous current lor five to ten minutes reduced the increased tempera- 
ture of the joint to the normal, markedly diminished the pains for a num- 
ber of hours and, upon daily repetition, secured a more rapid and less 
distressing course of the disease. These results were verified completely by 
Beetz in Ziemssen's clinic, and he regards the faradic current as a valua- 
ble palliative, which may be combined serviceably with other remedies. 
Abramovski saw the same brilliant results from the application of the 
&radic brush to the integument over the joints (ten to fifteen minutes 
daily), but did not detect any analgesia, at least of the skin. 

Since the employment of salicylic add you will not be inclined to re- 
sort to the galvanic or ftoudic current in the treatment of acute articular 
rheumatism. But since individual cases occur in idiich the administn^ 
tion of salicylic or benzoic acid is useless, you may resort oooasionaQy to 
the electrical current and, at all events, it is advisable as a tolerably certain 
palliative in combination with internal remedie& 



ObBOMIO IHVLAIOKATION OP THB JoiNTS. 

Among articular affections these constitute the real field for eleotrkily ; 
other methods of treatment are much more often useless, the disease con- 
tinues for years and thus afifords opportunity for the trial ot the electrioal 
current Those forms are more accessible to treatment in which the tis- 
sues surrounding the joints are chiefly affected and in which de^Mr de- 
structive changes of the cartilages and bones are absent 

1. Monoarticuiar chronic articular rheumatism is a quite frequent affec- 
tion which may be located in any joint, most frequentiy in ttie dioolder 
and knee, then in the elbow and foot. It is associated not uncommonly 
with an abundant collection of fluid, or merely with thickMiing of (1» tis- 
lues, stiffliess and great tenderness on movement^ roughness and creakiag 
in the joint, etc. It is combined very commonly with secondary, often 
considerable atrophy of the muscles, most marked in the deltoid and quad- 
riceps femcMis. It develops after injury, cold, gonorrhcea, and the like, is 
often spontaneous, frequentiy occurs upon a scrofulous basis (tumor albus) ; 
it is usually a very obstinate affection, and the ordinary surgical remedies 
(spirits iodine, massage, etc. ) may prove useless. 

This articular disease is one of the most favorable forms for electrioal 
treatment. The following are the methods of treatment which maybe 
adopted: 

As it is desirable to secure the catalytic effects of galvanism, stabile 



SPECIAL ELSCTBO-THEBAPSUTIOS. 881 

currents should be passed transrersely through the diseased joint in all 
directions ; the e£fect will be increased by changing the direction of the 
current a number of times. In recent cases feeble currents and the pre- 
dominant action of the An should be employed, in old eases stronger cur- 
rents and Tigorous action of the Ca. Exclusively labile applications to the 
adjacent muscles, blood-vessels, and lymphatics also appear to be very use- 
ful The duration of the sitting varies from five to twenty minutes. 

The faradio current may also be employed, the current being passed 
through the joint by means of moist electrodes or local baths ; the ear- 
rent should be quite strong, the sitting ten to fifteen minutes. Weisflog 
makes several applications daily from one-half to one hour in duration. 

The f aradic brush may also be tried, especially when vigorous counter- 
irritation of the skin around the joint is desired or great tenderness is 
present 

The secondazy muscular atrophy may be treated either by labile gal- 
vanic currents, Ca CI and changes of polarity, by regular faradization of 
the muscles, or finally, by the feeble, continuous galvanic currents so 
strongly recommended by Le Fort and Valtat (vide page 120). 

2. Polyarticular chronic articular rlieumatimi is often nothing more 
ttian a reduplicated variety of the affection just considered, or it develops 
sometimes as a sequela of a specific acute articular rheumatism. It ii^ 
under all circumstances, an annoying and obstinate affection, in whieh» 
however, electricity sometimes proves useful 

The treatment is carried out in the same manner as in the preceding 
form. Mixed treatment, like that employed by Erdmann (faradic brush, 
faradization and galvanization of the joints and muscles), may perhaps 
effect the desired object more rapidly. 

8. Arthritis deformana or rheumatismus nodosua is one of the most 
severe fcHrms belonging to this category, and usually resists the dectriiai 
current as obstinately as it does all other methods of treatmeni QpiB- 
ions differ with regard to tiie character of the disease. Probably sevenl 
forms should be differentiated : one which appears mainly in the large 
joints and the spinal column in advanced life (malum senile), another 
which occurs chiefly in the small joints of the fingers and toes, giving ris* 
to deformity and beginning in middle age (arthritis pauperum), and due 
mainly to rheumatic influences ; and finally, probably another form, whieh 
must be regarded as tropho-neurotic in its origin. 

The disease always lasts for years, sometimes throughout life, is char- 
acterized by the formation of nodules and deformities in the joints, violent 
pains, secondary muscular atrophy and general weakness. 

The case treated by Cohen with faradism and cured within six months 
probably belongs in this category ; Bemak reports favorable results from 
galvanic applications (chiefly in the form of diplegic excitation) ; Morits 
Meyer has also cured several cases by galvanization of the sympathetic ; 



832 ELECTRO-THKRAPEUnCS. 

Althaos obtained satdsfactory results from galvanization of the spine and 
joints. The results obtained by Cheron are so brilliant that they are 
scarcely credible. I have treated an entire series of cases, but almost 
always without any success whatever. 

In addition to local treatment of the joints, which should be carried 
out in the same manner as in the other forms of chronic rheumatism, we 
may recommend regular galvanization of the cervical sympathetic and the 
corresponding nerve plexuses, perhaps still more of the spinal cord itsell 
The relief of the general weakness and muscular atrophy, the improve- 
ment of the nutrition of the skin, and the frequent anomalies of the secre- 
tion of sweat, etc., are best effected by labile galvanization of the plexus, 
the principal nerve trunks, and the muscles of the extremities. In addi- 
tion, trial of general faradization and the electrical bath is justifiable. 
The sittings should last from ten to fifteen minutes or more. 

4. Ankylosns, stiffness of Ike joints^ periarthrUic swellings^ etc, which 
are observed not infrequently after traumata, gun-shot wounds, prolonged 
application of surgical bandages, etc., have also been the subject of suc- 
cessful electrical treatment Moritz Meyer observed the disappearance of 
these affections after application of the galvanic current, mainly of the 
anode. It is immaterial whether one pole or the other is employed ; it 
is probably better to use both alternately in order to secure the most 
intense catalytic action possible. But massage probably will be the most 
successful rival of electro-therapeutics in this field. 



Diseases of GtLANDULAB Qbgans. 

Bemak relates in his book on galvano-therapeutics (page 293) that he 
succeeded in relieving a row of swollen and painful cervical glands and in 
diminishing large goitres which had existed for a long time. Similar re- 
sults have been obtained since by other observera 

Seeger, Chvostek, Onimus, Legros, and Picot have employed the gal- 
vanic current for the relief of tumors of the lymphatic glands, and regard 
the stabile and labile passage of a current through them and the adjacent 
lymphatics as the best method of treatment It is better, probably, to 
apply both poles in succession, though perhaps the An may be applied 
for a longer period in one case, the Ca in another. 

The faradic current has also been employed successfully in a few cases. 
Duchenne relieved enlargement of the cervical glands by means of ftura- 
dism, and Moritz Meyer reports a case in which a cervical gland, as large 
as a hen's egg, was reduced by the faradic current to the size of a plum- 
pit in sixty sittings, and finally, the very remarkable observation of a 
tumor of stony hardness, situated between the head and the scapula, and 
larger than the head, which was reduced to a minimum by means of the 



SPECIAL ELEOTROTHEKAPEUTICS. 333 

&radic current (two hundred and Beyentjthi*ee sittings of one to one and 
a half hour each). Meyer has found recently that frequent interruptions 
of a very strong &radio current, passed through the glaaduhu: tumors for 
five to ten minutes, produce a separation of the sweUing into several 
smaUer glands, and thus markedly accelerate their absorption. 

Chvostek has published a large series of observations concerning the 
galvanic treatment of goitre ; in some cases he obtained remarkably rapid 
relief, frequently merely a partial diminution of the goitre, and in rare 
cases no results whatever. His plan consists in the daily passage of a 
stabile current for five to ten minutes. 

Mention should be made also of the various attempts which have been 
made to diminish the size of an enlarged spleen by means of electrical 
currents. Chvostek has come to the conclusion that the electrical current 
may produce a distinct diminution of the spleen, demonstrable by percus- 
sion ; this is effected in a reflex manner, the integument in the region of 
the spleen being vigorously faradized with two brushes for a period of 
about three minutes at each sitting. This author, who reports a number 
of striking results, and even in cases which did not yield to large doses of 
quinine, attributes them to reflex contraction of the smooth muscular 
fibres in the spleen, and even more to contraction of the blood-vessels 
themselves. 

Botkin, who applies the faradio current to the enlarged spleen by 
means of moist electrodes, observed diminution of the size of the organ 
in leucaemia ; Beyer obtained similar results, but faradization proved use- 
less in the hands of Elias and Hosier. Skorczewsky found that faradiza- 
tion of the spleen (moist electrodes, strong current) produced a diminu- 
tion in the size of the organ almost constantly (the enlargement was due 
to malaria). 

Faradization of the spleen and vicinity may be recommended, there- 
fore, in all obstinate cases of enlargement of this organ which resist other 
methods of treatment. 



DXBBASSS OF THE ThOBAOIO ObOANS. 

The electrical treatment of pulmonary and cardiac affections has been 
tried hitherto in very few forms of disease and very little can be said con- 
cerning it. 

Nervous asthma occupies the foremost position with regard to electrical 
treatment. On account of the imcertainty of our views concerning the 
real nature and site of asthma, no slight difficulties arise with regard to 
the choice of the location and the form of the application of electrical 
currents. We are still undecided whether we have to deal with a spasm 
of the bronchial muscles or of the diaphragm, with a vasomotor swelling 



S34 ELECTBO-THEBAPEUTIOS. 

of the bronchial mucous membrane, with a disturbance in the domain at 
the pneumogastric or the sympathetic, with a direct excitation of iheat 
tracts or a reflex production of the asthmatic process, and finally at what 
point this direct or reflex irritation is situated. 

We are therefore restricted to a purely empirical method of treatment 
From the observations hitherto made, it follows that imdoubted results 
can be attained in bronchial asthma by the use of electricity. Ca^Mai 
cured a case, which had lasted a number of years, with the galvanic car 
rent, the Ca being placed upon the sacrum and the An dowly stroked 
along the spine from the neck to the lumbar vertebrse for ten to twentf 
minutes; recovery ensued after twenty-five sittings. Brenner observed 
considerable relief in a severe case of asthma from the application of the 
galvanic current to the pneumogastric (An in the neck, Ca between the 
larynx and the flexors of the head). Neftel systematically treated a s^iei 
of cases with galvanism and states that he obtained surprising results. 
Starting from the assumption that asthma is due to an implication of the 
pneumogastric nerve, he made this nerve the special subject of treatment 
according to the polar method. It was found that in the majority of cases 
the application of the An, in others the Ca, to the pneumogastric had a 
brilliant effect ; the Ca was specially e£fective in stopping the individual 
attacks. Neftel begins the application with a feeble current^ and increases 
it with the aid of the rheostat until the attack is amelicnrated, then gradu- 
ally diminishes the strength of the current ; duration of the sitting, two to 
ten minutes, at first daily, then less frequently. Schmitz also employed 
the galvanic current in a case of asthma and emphysema in which the at- 
tacks were always preceded by severe nasal and bronchial catarrh. The 
application of the electrodes on each side of the thyroid cartilage at the 
inner border of the stemo-mastoid produced immediate relief of respira- 
tion and copious expectoration. Schaeffer, on the other hand, obtained 
no benefit from galvaniun, but secured brilHant results from ihe applica- 
tion of the faradic current In accordance with his view that asthma is 
due very generally to an irritation of the nerves in the upper part of the 
respiratory tract (nose, pharynx, larynx, trachea), he applies both elec- 
trodes of a vigorous &radic current (for one-quarter to one-half hour) 
either immediately below the angle of the jaw or at the level of the thyroid 
cartilage. The applications are made in this manner, at first twice a day, 
later more infrequently and briefly. Schaeffi^ states that he has cored a 
number of cases in this way, and Bresgen also reports good results. 

But numerous further observations are necessary before we can decide 
upon the value and the special indications of the individual plans of treat- 
ment. 

The electrical treatment of angina pectoris has been discussed in Lec- 
ture XXYI, page 255. 

It does not seem irrational to employ electricity in the treatment of 



SPECIAL ELECTB0-THEBAPEUTIC8. 335 

nervous palpitatwn of the heart. Flies alone appears to have employed 
this agent in a larger series of cases. In twenty-four cases of palpitation, 
five of which were associated with organic cardiac disease, he observed 
improvement in all, and in numerous instances (not associated with or- 
ganic disease) complete recovery occurred after a few (five to six) sittinga 
His method consisted in the application of a moderately strong galvanic 
current to each vagus, for one to two minutes daily ; the descending cur- 
rent is said to have had a better effect than the ascending. In the begin- 
ning the efCBot was merely subjective but soon became noiioeable objec- 
tively by a diminution of the frequency and intensity of the action of the 
heart. I have also treated a case of severe palpitation and irregularity of 
the heart with iutense cardiac asthma (probably due to organic disease), 
with the galvanic current (to the pneumogastric in the neck and the region 
of the heart), with relatively very favorable palliative results. I know of 
no other similar obsorvations. 

As a matter of course, it is entirely rational in such cases to appeal 
first to the inhibitory action of the pneumogastric and to stimulate this 
nerve with the current. Whether cases do n9t occur in which a depress- 
ing effect upon the cervical sympathetic or the excitomotor centres in the 
spinal cord (An stabile upon the cervical cord) will produce a similar effect 
oan be determined alone by further experience. 

In addition, trial may be made of the direct action of the galvanic 
current upon the intracardial nerves, according. to Ziemssen's method, in 
order to regulate the action of the heart This procedure consists in the 
passage of very strong currents from the spine to the cardiac region with 
very large electrodes, and with changes of polarity regularly performed at 
definite intervals. An increase in the frequency of the heart's action may 
be readily effected ; diminution of the number of beats requires very con- 
siderable strength of current, at least in the normal heart It goes with- 
out saying that great caution is necessary in such experiments. 

In like manner it does not seem to be unjustifiable to make such 
experiments in weakness and irregularity of the heart, Ziemssen's method 
may be specially recommended in this connection, particularly the sta- 
bile passage of strong galvanic currents through the heart (also without 
changes of polarity), which produces an acceleration of the heart-beats in 
a regular rhythm (probably from direct stimulation of the ganglia of the 
heart) when applied at certain points (the auriculo-ventricular groove and 
its vicinity). Galvanization of the cervical cord, the pneumogastric and 
ii^^mpathetio may also be employed. 






LECTURE XXXV. 

DiMiflM of the DigentiTe Oigans : Nemotee of the OBsophigiis— Bieeaaee of the Stom- 
ach: Nervous Vomitiiig ; CardiAlgut; Nerroos Djtpepsia; Methods of Eleotrioal 
Treatment; Atonj and Dilatation of the Stomach-^Diseases of (he Intestiiiee: 
Nervons Enteropathy; Enteralgia; Atony and Paralysis of the Mnsonlar Coat 
of the Intestines: 1. Occlusion of the Intestines hy Atonic Aooomolatiaii of 
Fasces ; Pathology ; Cases ; Methods of Electrical Treatment ; InTaginati<Ki of 
the Intestines ; 2. Chronic Constipation from Atony of the Intestines ; Cases ; 
Percntaneous Faradization ; Becto-abdominal Faradisation ; Galvano-faradiai^ 
tion; 8. Prolapsos Ani; Paresis of the Sphincter Ani; Ascites; its Fasidlo 
Treatment. 



Dtbrabrr of thb DiaksnvE Obganb 

merit our attention, cbieflj with regard to the digestiTe canal itself wfaHe 
much less significance attaches to the larger and smaller glandular ap- 
pendage& 

Spasm and paralysis of the oesophagus alone are very rare pathological 
phenomena, but occasionally may become the subject of electrical treat- 
ment This must be done according to general principles, preferably by the 
introduction of an electrode (an oesophageal bougie provided with a metal- 
lic tip) for a variable distance into the cesophagus, while the other elec- 
trode is placed upon the back of the neck, the dorsal vertebrae, or the 
sternum. Both currents are applicable, but it is advisable to be very cau- 
tious in the choice of the strength of current on account of the proximity 
of the pneumogastrics, since their excessive irritation might be attended 
with dangerous consequence& 

Brenner rapidly cured a peculiar sensory neurosis of the oesophagus, a 
sort of nervous heartburn without other dyspeptic symptoms (vagus neu- 
rosis?), by the application of the galvanic current to the region of the 
pneiunogastric nerve (An at the back of the neck, Ca between the larynx 
and stemo-mastoid, three minutes, with a few interruptions). 

The investigations with regard to the electro-therapeutics of diseases of 
the stomach are more niunerous and important. 

The functional affections of this organ alone merit our attention. 
Various observers have obtained good results from the electrical current 
in nervous vomiting, as it occurs in hysteria, in pregnancy and child-bed, 
in migraine, dysmenorrhoea, etc. The methods adopted are more or less 



4 

SPECIAL ELECTRO-THERAPEUTICS. 337 

empirical ; either faradization of the gastric region, from the spine to the 
epigastrium, or from the neck to the epigastrium, or both poles upon the 
region of the stomach, with tolerably strong currents; or galvanization 
performed in the same manner ; or galvanization of the neck and the cer- 
vical cord. Improvement occurred in the majority of the cases reported.* 

The treatment of nervous cardialgia has been discussed in Lecture 
XXVL, page 266. 

Special interest has been attached recently to so-called nervous dyspep- 
sia, and the voices of some authors have been raised in favor of its electrical 
treatment. Opinions differ, however, with regard to what should be called 
" nervous dyspepsia." If^ with Leube, we include only those cases in which 
digestion is normal with regard to duration and its chemical relations, but 
various disagreeable and annoying local or general symptoms occur dur- 
ing digestion (either as the result of abnormal irritability of the gastric 
nerves themselves or of the entire nervous cfystem), the notion of nervous 
dyspepsia, in my opinion, would be too narrow. There can be no doubt 
that cases occur in which abnormal digestion may present the symptoms 
of nervous dyspepsia, due to deficient innervation of the glands of the 
stomach or to insufficient activity of its muscular coat. In one series of 
cases, therefore, the nervous dyspeptic disturbances occur during normal 
digestion, while in another series digestion itself is rendered abnormal by 
primary nervous disorders. But both forms are closely associated, and 
cannot be sharply separated in practice ; the electrical current is often a 
suitable remedy for both varieties, in addition to other measures which 
are indicated by the general condition of the stomach. 

The diagnosis of these conditions is not always easy, but careful ob- 
servation and examination and the exclusion of organic affections of the 
stomach will often permit their recognition with certainty. 

In the electrical treatment both currents may be employed in various 
ways according to the predominant symptoms. Beard and Rockwell 
recommend general faradization and undoubtedly with justice, since 
the majority of these patients also suffer from general neurasthenia. 
They also recommend galvanization of the pneumogastric, sympathetic, 
and spinal column and later central galvanization. Leube employs in 
part strong faradic currents (from the back to the epigastrium), in part 
the galvanic current, almost always as an external application, the An in 
the epigastrium, the Ga upon the dorsal spine, with a tolerably strong 
current. Burkart saw admirable results from the application of the gal- 
vanic current in a similar manner ; he presses the An as deeply as possi- 
ble into the region of the abdominal plexus, which is tender on pressure, 
and applies the Ga to the back with a stabile current. Stein prefers the 
faradic current and passes it transversely through the abdomen from one 
hypochondrium to the other with large flat electrodes, employing a cur- 
rent of moderate strengtL 
22 



338 ELECTBO-THBBAPSUTICS. 

The faradic current should be employed first, especiallj if atonj of 
the stomach and intestines is also noticeable ; if abnormal senaationa, 
hypersBsthesia of the gastric nerves and the like predominate, a trial of the 
galvanic current (anodal application) appears justifiable, particularly when 
the abdominal plexus is distinctly tender on pressure. Both currents may 
also be employed alternately. In addition, the methods generally adopted 
in neurasthenia may be tried, and in obstinate cases treatment of the pneu- 
mogastric and sympathetic in the neck and along the spine, perhaps also 
central galvanization and general faradization should not be omitted. 

Atony and dilcUcUion of the stomach are observed not infrequently in 
connection with nervous dyspepsia. 

Atony of the stomach is a very common symptom in all possible dis- 
eases of the nervous system, especially in general nervous debility and in 
many central diseases. It may also occur as the result of chronic gastric 
affections, of continued and frequently repeated distention of the organ 
with an excessive amount of food and the like. After it has existed for a 
certain length of time, it gives rise, as a rule, to dilatation of the stomach 
and this may be attributed, in turn, to various pathogenic factors. Some 
cases are of traumatic origin from a blow or fall upon the epigastrium, 
especiaUy in nervous, hysterical individuals ; others result from gastric 
catarrh and atony of the muscular coat induced thereby; others arise 
from a relatively excessive strain upon the walls of the stomach by a large 
amount of food, and distention in consequence of development of gas or 
stagnation of the ingesta ; the latter forms are especially frequent in 
stenosis of the pylorus. 

In all these coses electricity may be employed for the purpose of 
stimulating the contractions of the stomach and relieving the atony which 
constitutes, under all circumstances, one of the chief conditions for the 
relief of the gastric dilatation. As a matter of course, the latter must also 
be treated by other remedies (especially the stomach-pump) and, above 
all, an attempt should be made to meet the causal indications. But even 
in such cases electricity should be employed as an auxiliary measure, 
and whenever we have to deal with purely nervous atony and ectasia of the 
stomach, electricity is undoubtedly the sovereign remedy. 

The methods recommended by individual authors are not identicaL 
Onimus advises the application of the galvanic current (from the epigas- 
trium to the back, and from the lesser to the greater curvature), while 
almost all other authors employ the faradic current in preference. Fuerst- 
ner applies one electrode of a vigorous current to the left hypochon- 
drium, the other to the region of the stomach, and moves the latter with 
strong pressure along the greater curvature toward the pylorus. Neftel 
applies both electrodes upon various diametrically opposite points of the 
surface of the dilated stomach, allowing increasing induction currents to 
pass ten to twenty times in succession. 



SPECIAL ELECTROTHERAPEUTICS. 339 

It appears to me to be most serviceable to apply a large electrode to 
the back, immediately to the left of the spinous processes at the level of 
the cardiac end of the stomach, while the other somewhat smaller elec- 
trode is placed first upon the epigastrium and then successively upon the 
other parts of the entire surface of the gastric region ; the current should 
be strong enough to produce vigorous contractions of the abdominal 
musclea In galvanic applications, the An is placed upon the back, the 
Ca labile over the stomach, for three to eight minutes daily. It seems 
particularly useful to hold the sittings immediately after the stomach has 
been pumped out. 

Tou will rarely find occasion for the internal application of an elec- 
trode by means of a suitable oesophageal sound. 

The electro-therapeutics of diseases of the intestines also deals chiefly 
with functional nervous disturbances. 

Nervous enteropathy y which occasionally forms a symptom of nervous 
dyspepsia and is manifested in a similar manner, except with regard to 
localization, is treated in the same way as the latter affection. As a 
matter of course the current will be applied more to the intestines and 
the hypogastric plexus of the sympathetic. 

By far the most important object in these affections is the employment 
of electricity fox* the purpose of stimulating intestinal peristalsis, in aU 
possible conditions, varying from atony to complete paralysis of the mus- 
cular coat of the intestines. 

These frequent and annoying conditions constitute very grateful 
objects of electrical treatment, but they must be separated into two 
varieties : 

1. Occlusion of the intestines by atonic stasis offceces. — In this condition, 
after previous more or less obstinate constipation, complete obstruction 
occurs suddenly (from indigestion, distention of the stomach, intestinal 
catarrh or the like), with enormous accumulation of faeces, marked meteor- 
ism, severe pains, and not infrequently with very grave symptoms, which 
may be increased to ileus. It is naturally difficult to differentiate this 
form from other varieties of occlusion of the intestines (from invagination, 
internal strangulation, volvulus, etc.) ; the previous constipation, the 
demonstration of large masses of faeces, the prolonged absence of fever, 
perhaps previous similar conditions may render the diagnosis easier. 
Moreover, electrical excitation of the intestines in the other forms of 
occlusion would not produce any notable bad effects, and need be omitted 
only when peritonitis is distinctly developed. Indeed, Curci recommends 
electricity as a differential diagnostic measure in occlusion of the intes- 
tines from obscure causes ; if improvement does not occur after one or 
two sittings we may assume a mechanical obstruction. 

An entire series of observations have been reported in which, in these 
acute cases, after cathartic remedies and procedures had proven absolutely 



340 ELECTRO-THEBAPEUnCS. 

useless and tlie symptoms bad increased partly to a threatening extent, 
the energetic application of electrical currents was sufficient to excite in- 
testinal peristalsis, and produce an evacuation of the bowels and recoTery. 

163. Observation by Hofmann, Typhlitis stercoralis ; paralysis of the 
muscular coat of the intestines ; ileus, — In a woman, aged* seventy-two 
years. After protracted constipation, meteorism developed with foul eruc- 
tations, and finally frequent vomiting with a fecal odor. Cathartics and 
enemata useless. Faradization of the intestines (one pole in the rectum, 
the other in the right iliac region) for a quarter of an hour with a strong 
current produced an evacuation from the bowels and recovery. 

164. Observation by Mario Oiommi, Obstruction relieved by faradization, 
— A farmer, aged fifty-one years. July 22d suffered from abdominal pain, 
followed by a few small stools and then by obstinate constipation. Au- 
gust 8th admitted to hospital ; enormous meteorism, eructation of odor- 
less gas, difficult breathing, dry tongue, etc; resonant percussion note. 
Diagnosis of simple atony of the intestinal muscular coat and faradization 
recommended, after cathartics, etc., had proven useless. Faradic treat- 
ment, one electrode- in the rectum, the other upon the abdomen over the 
transverse colon ; vigorous current. First sitting of fifteen minutes ; no 
result Next morning, second sitting of twenty minutes ; shght discharge 
of yellowish masses ; at night after the third sitting, two copious evacua- 
tions ; after the fourth sitting, further evacuations and then progressive 
improvement until recovery. Discharged September 2d., 

165. Observation by J. Simon. Intestinal obstruction ; colic and ileus ; 
rapid recovery under electricity, — A man, aged forty-four years. Suddenly 
seized on June 15th with vomiting and colic ; no fever. Obstinate consti- 
pation with increase of pain ; gradual development of meteorism. Enemata 
and cathartics useless. No hernia or mechanical obstruction demon- 
strable. Increasing distention of the abdomen, anxiety, complete con- 
stipation, repeated vomiting; pulse frequent and thready. Symptoms 
continued to increase and electricity employed on night of Jime 17th. 
Faradization of abdomen and intestines, alternating with labile galvanic 
currents ; twenty minutes. Vomiting ceased immediately and two fluid 
stools were passed. A second sitting at the end of three hours, followed 
during the night by twelve stools and copious discharge of gas. June 
18th, continuance of the fluid evacuations ; diminution of aU the symptoms 
and undisturbed convalescence. 

The majority of authors employ the faradic current in this condition, 
but Wharton has also apphed galvanism successfully. He introduced one 
pole into the rectum, placed the other over the csecal region, and passed a 
current of 14 elements vrith frequent interruptions for ten minutes. In 
the faradic treatment one pole is also introduced into the rectum and the 
other (Ca) stroked over the entire abdomen, with a very powerful current, 
so that vigorous contractions of the abdominal muscles ensue. The dura- 
tion of the sitting is five to twenty minutes. Ballouhey describes a 
mixed method ; at first, percutaneous labile application of the galvanic 
current to the abdomen, the An as near as possible to the point of occlu- 
sion ; then abdomino-rectal faradization in the ordinary manner, and in 



SPECIAL ELECTRO-THERAPEUTICS. 341 

oondosion a similar method of galvanization (Ca in the rectum) with 
frequent interruptions ; several repetitions of the entire procedure during 
each sitting. 

The sittings may be repeated two or three times a day until relief 
occurs. This is shown by the discharge of gas and of more or less copi- 
ous, often enormous evacuations from the bowels, which occur not infre- 
quently immediately after faradization, but usually after the lapse of an 
hour or more. 

I will mention also that Bucquoy has successfully treated xnvagin€Uion 
of the intestines, as it occurs commonly in children, with the faradic 
current ; he advises its employment before any inflammatory complication 
has arisen. Two or three sittings of ten minutes' duration are said to be 
sufficient, as a rule, to produce an evacuation and relieve the invagination. 
As a matter of course, other methods of treatment should not be neglected. 

2. Chronic constipation from atony of the intestines is an extremely 
frequent condition. It is observed very generally in all possible nervous 
affections, in hysteria and hypochondriasis, particularly in neurasthenia 
with or without nervous dyspepsia ; also in almost aU chronic spinal affec- 
tions (myelitis, ataxia, etc.), and in certain cerebral diseases, epilepsy, etc.; 
it is especially frequent in women on accoimt of improper habits of life, 
deficient exercise, eta, and not rare in young girls at the period of 
puberty ; also as a result of chronic intestinal catarrh, hemorrhoids, 
chronic peritonitis ; and finally, an important cause of this condition is 
the wide-spread misuse of purgatives, especially of the stronger drastic 
remedies 

Electricity is an admirable agent in this condition, and my large ex- 
perience corroborates entirely the favorable reports furnished by Benedikt^ 
Scarpari, Guenther, and others. 

16G. Fefrsonal observation. Epilepsy ; severe constipation. — A student, 
aged twenty years. Suffering from epilepsy and from so severe constipa- 
tion that he had not had a passage for years, except after administration 
of active purgativea After regular faradization of intestines for several 
weeks, evacuations occurred without medicine for several years. 

167. Personal observation. Nervous headache ; habitual constipation. — 
A girl, aged nineteen yeara Suffering from violent nervous headaches 
and habitual constipation ; was reUeved of the latter symptom, in great 
part, by regular faradization of the intestines. At all events, the faradic 
current proved much more effective than all other purgative remedies. 

168. Personal observation. Gunshot ivound of abdomen and spine ; ob- 
stinate constipation, — An officer, aged twenty-six years. August 30, 1870, 
received a gunshot wound in abdomen, entering the right hypochondrium 
anteriorly, emerging on left side of fourth lumbar vertebnr, followed 
by complete paraplegia with paralysis of sphincters ; gradual improvement 
during the winter ; 5ie left limb regained power, the right leg remained 
completely paralyzed ; neuralgic pains, insomnia, retention of urine. 
Patient had not had a single spontaneous evacuation during this entire 



342 ELEOTBO-THBBAPEUTIGd. 

period, except when diarrhoea existed from some cause ; castor-oil or 
enemata employed regularly. 

June, 1877. — Gkdvanic treatment of paralysis begun ; castor-oil grad- 
ually lost its effect. 

July 5th. — Constipation ; then percutaneous faradization of the intes- 
tines, followed during the night by a profuse evacuation without the use 
of purgatives. 

July 7th. — Scanty stool ; second faradization. 

July 8th. — Normal stool ; faradization. 

July 9th. — Stool in the morning ; faradization in the affcemoon, fol- 
lowed by copious evacuation shortly afterward. 

July 10th. — Faradization in afternoon, followed by stooL 

July 11th. — Stool in the morning ; faradization ; copious evacuation at 
night 

July 23d. — Patient left for Wildbad ; reports, upon his return, that 
the evacuations from the bowels were much better, and that purgative 
were rarely required, although large doses of morphine were administered 
regularly. 

169. Personal observation. Obstinate cofistipation in consequence of peri- 
tonitis. — ^A man, aged twenty-three years. During last winter had severe 
perifcyphlitis with pericystitis, etc. ; since then has suffered constantly from 
constipation. No spontaneous evacuations, except when diarrhoea was 
present 

July 9th. — Began percutaneous faradization of the intestines, and ca- 
thartic pills were discontinued. From the very first day, spontaneous 
passages occurred regularly, with few exceptions, either in the afternoon, 
soon after faradization, or upon the following morning. Treatment was 
continued until August 23d ; injections were required occasionally. The 
improvement continued many months, and, at a later period, was rendered 
permanent by repetition of similar treatment. 

170. Observation by Stein, Habitual constipation, — A girl, aged eighteen 
years. Began to menstruate four years ago, and since then has suffered 
from obstinate constipation, so that not a single evacuation has occurred 
vnthout administration of purgatives. Anorexia and mental depression. 
A moderately strong faradic current was passed, for ten minutes, trans- 
versely through the abdomen. In the beginning, spontaneous evacuations 
occurred at intervals of two or three days, and after the nineteenth sitting, 
every day. Recovery was complete after twenty-eight sittings ; since then 
the patient has had a good appetite, blooming appearance, cheerful dis- 
position. 

The electro-therapeutic methods in habitual constipation permit a 
gradual intensification according to the severity and obstinacy of the case. 

As a rule, I begin with the percutaneous application of the faradic 
current The An (" large ** electrode) is placed upon the upper lumbar 
vertebrae, the Ca ("medium" electrode) is slowly passed over the entire 
surface of the abdomen ; in the region of the caecum the electrode is 
pressed in more deeply and allowed to remain stabile for some time, then 
passed along the colon to the left iliac region, where it is also pressed in 
more deeply, then in a circle around the umbilicus and over the entire 
abdomen. The current should be so strong that vigorous contractions of 



SPECIAL ELEOTBO-THEBAPEUTIOS. 348 

the abdominal muscles can be produced. But it seems serviceable to 
avoid these contractions, since thej interfere with the passage of the cur- 
rent more deeply ; it is therefore better to apply the electrode at a dis- 
tance from the motor points. The duration of the entire sitting should be 
from three to ten minutea In addition, I sometimes pass a current of 
varying direction, transversely from one hypochondrium to the other, the 
electrodes being pressed as deeply as possible into the loins. 

To secure more vigorous action I then introduce an electrode into the 
rectum, the other being applied to the abdomen in the manner described 
above. An olive-shaped, metallic electrode, which is insulated to the 
tip, is introduced six to eight centimetres or more into the rectum ; 
this gives rise to no sensation, or, at the most, to a slight feeling of 
pricking and burning, if the Ca is introduced. It is advisable to change 
the direction of the current several times, in order to allow the Ca, which 
is the more vigorous excitant, to act occasionally upon the rectum. The 
active contractions of the abdominal muscles should be the measure of the 
strength of the current; the duration of the sitting varies from three 
to ten minutes. (If the galvanic current is employed, prolonged closure of 
the circuit should be avoided, in order to prevent the formation of eschars ; 
repeated changes of polarity should be made with a very short period of 
dosure of the circuit.) 

If this method proves insufficient, I precede it by an application of the 
galvanic current directly to the abdomen (An on the back, Ca stabile and 
labile and repeated closures, perhaps also changes of polarity), and also to 
the region of the splanchnic nerves in the dorsal sympathetic (An in the 
small of the back, Ca stabile and labile on both sides of the spinous pro- 
cesses of the fifth to the twelfth dorsal vertebra?) ; this application need 
not last more ^han a few minutea 

These various methods of treatment, as a rule, are followed very soon 
by an improvement of the atony of the intestines and the constipation. 
The purgatives, which are still required at the onset, become more effect- 
ive, their dose may soon be diminished, then a spontaneous evacuation 
occurs occasionally, and the purgatives may be dispensed with gradually 
or reduced to a minimum ; finally, complete recovery may ensue. This is 
usually followed by a very favorable effect upon the disposition and gen- 
eral condition of the patient It is hardly necessary to state that certain 
forms of habitual constipation resist aU electrical treatment 

Prolapsus ani and paresis of the sphincter ani may be mentioned as the 
last form of disease belonging to this category. These conditions occur in 
little children as the result of constipation and weakness, in adults, from 
hemorrhoids and obstinate constipation, from violent straining at stool, 
and not infrequently from spinal and peripheral paralyses. Good results 
have been obtained with the electrical current in these affections, especially 
in those forms due to atony of the sphincter, while the prognosis of paral- 



I 

1 



344 ELECTBO-THERAPEUnCS. 

ysis oif the sphincter from diseases of the spinal cord naturally depends, in 
the main, upon the primary affection. 

The chief indication in treatment is faradization of the rectum hy the 
aid of the rectal electrode. In addition the intestines and sphincter ani 
may be stimulated by means of the galvanic current (changes of polaritj), 
either with the rectal electrode or percutaneously from the sacrum to tiie 
perineum ; and finally the nerves of the sacral plexus may be stimulated 
in the ordinary manner. 



In conclusion, I vnll mention that ascites has been repeatedly made the 
subject of electro-therapeutic measures, and not without succes& In all 
cases the method consisted of vigorous faradization of the abdominal walls 
for ten to fifteen minutes. 

Glaz and Sigrist laid special stress upon the frequently repeated stimu- 
lation of the individual motor points of the abdominal muscles. The re- 
sults were surprising in the majority of cases. The excretion of urine in- 
creases, the ascites diminishes and may disappear entirely in a short time. 
As a matter of course, however, the duration of recovery depends upon the 
primary disease. 



XIL DISEASES OP THE URINARY AND SEXUAL 

ORGANS. 



LECTURE XXXVI. 

of the Bladder. Introdnotioii. Yeuoal Spasm ; GauBal and Direct Treat- 
ment — Paralysis of the Bladder: Various Forms; Pathogenesis; Causal and 
Direct Treatment ; Percntaoeous and Internal Applications ; Galvanization of the 
Lnmbar Cord — Nocturnal Enuresis : Its Nature ; Methods of Treatment — Diseases 
of the Male Sexual Oi^ans : Inflammation and Hypertrophy of the Prostate ; 
Oiohitia— Functional Disorders: Impotence; Pollutions; Spermatorrhoea; Asper- 
matiam ; Pathogenesis ; Causal and Direct Treatment — Diseases of the Female 
Sexual Organs — Introduction — OTarian Hypersesthesia — Disturbances of Menstrua- 
tion: Amenorrhoea; DysmenorrhoBa ; Menorrhagia — Chronic Metritis — Changes 
in the Po)>ition of the Uterus — Deficient Secretion of Milk — Concluding Remarks — 
Contra- indications to the Employment of Electricity — Condition of the Circulatory 
Organs and Mode of Reaction of the Nervous System. 

In conclusioi], we will enter upon a wide and varied field, viz. : disturb- 
ances of the urinary and sexual organs. These are extremely frequent in 
a great number of diseases (not merely those of a nervous origin), and not 
uncommonly are of great importance with regard to the course of the dis- 
ease as well as of the general vital conditions of the individual The most 
important organ in this connection is the bladder. Disturbances of the 
fimctions of this viscus are very common, partly as sequelse and symptoms 
of nervous diseases, both of peripheral affections (in the cauda equina or 
the pelvic plexus, the vesical nerves, etc. ) and particularly of spinal, more 
rarely of cerebral diseases ; in part they occur isolated, as the result of 
cold, abnormal distention, or inflammation of the organ, partly as the re- 
sult of reflex irritation or toxic agents which irritate the vesical mucous 
membrane, or act by paralyzing or stimulating the muscular coat of the 
organ. The circumstances under which vesical disturbances occur may 
accordingly vary greatly ; sometimes they are isolated, more frequently 
they are part symptoms of a complicated clinical history*, not infrequently 
they precede for a long time, as an isolated initial phenomenon, the symp- 
toms of a central affection (locomotor ataxia, myelitis, and the like). 

Electrical treatment may come into question iu almost all these forms 
of disease, especially in those which are not associated with gross inflam- 



346 ELEOTBO-THEBAPEUnCS. 

matory or neoplastic affections of the bladder, and which are not doe ta 
mechanical injury from lesions of the adjacent organs (jurostate, rectum, 
uterus, ovaries, etc.). 

This is less true of so-called ^yasm of the bladder, or tenesmus vesioat, 
which maj occur in the form of a spasm of the detrusor (spasmodic incon- 
tinence), or as a spasm of the sphincter (spasmodic retention of urine, spas- 
tic ischuria). We then endeavor to attain our object, as a rule, by other 
means, especially if we have to deal with an inflammatory affection of the 
bladder itself. But there are also purely nervous forms of vesical spasm 
which may fall entirely in the domain of electro-therapeutics. We must 
first look, therefore, for the cause of the abnormal irritation and remove 
this. In this connection a disease witliin the spinal canal and in the cord 
itself must be thought of and, if present, treated in the proper manner. 
This may be done by stabile galvanic currents through the lumbar cord 
and the lower part of the spine or by the stabile application of the An upon 
the supposed site of disease ; or, by means of vigorous stimulation of 
the skin, a counter-irritation may be produced which will remove the 
8pasm-pi*oducing irritant, as in the treatment of neuralgia ; the latter ob- 
ject is effected by the application of the faradic brush to the integument 
over the symphysis, perineum, sacrum, etc. 

Direct treatment of vesical spasm depends upon the same principles as 
the treatment of spasm in general, viz., stabile application of the galvanic 
current (gradually increased and diminished), with predominant action of 
the An upon the site of the morbid irritation — a requirement which is not 
readily fulfilled in treating the bladder. It is best to press one electrode 
deeply above the symphysis, the other (An) directly opposite upon the 
sacrum or upon the perineum. The same points of application should 
also be chosen in the employment of the faradic current. 

I do not think that the urethral or rectal electrode is indicated in vesi- 
cal spasm, as the condition of irritation is readily increased by their use, 
and there is danger of the formation of eschars from application of the 
galvanic current in this manner. 

But the true field of electro-therapeutics in vesical affections is weak- 
ness and paralysis of the bladder. This frequent and important symptom 
may vary from the slightest indication to the most severe form ; at times 
it is reheved rapidly, at times it is incurable and leads to the gravest dan- 
gers. It plays a particularly important part in spinal affections (ataxia, 
compression, hemorrhage, myelitis, sclerosis, etc.) ; also in the most varied 
peripheral nerve lesions, which affect the vesical nerves within the cauda 
equina or in the sacral plexus or its branches. This symptom is much 
rarer in cerebral diseases, so much the more common in hysteria. Finally, 
paralysis of the bladder may occur isolated, with or without a demonstrable 
cause (cold, injury, concussion, distention, opium poisoning, etc.). 

Paralysis of the bladder may occur in various ways ; if it affects chiefly 



SPECIAL BLECTBO-THERAPEUnCS. 34? 

the detrusor, the phenomena of retention of urine are presented ; if it af- 
fects mainly the sphincter, incontinence of urine is produced. Not infre- 
quently both parts of the muscular structure of the organ are paralyzed at 
the same time — the patients cannot retain the urine, nor can they dis- 
charge it voluntarily. In such an event, either an occasional complete 
and regular, but involuntary evacuation of the bladder occurs (if the re- 
flex apparatus in the lumbar cord is unimpaired), or there is a constant 
dribbling, though the bladder may be dilated at the same time by the ex- 
cessive stasis of urine. It would lead us too far to enter into all the de- 
tails concerning the innervation of the bladder and the various possibilities- 
of its disturbance in different parts (in the muscular coat, the peripheral 
nerves, the lumbar cord with its centres of micturition ; or, above them, 
in the sensory and motor tracts for the innervation of the organ, which 
pass to the brain). 

But it is indispensable to rational electrical treatment that an attempt 
be made to ascertain in each individual case the character and localization 
of the disturbance, the manner in which it was produced, and particularly 
the exact site of the paralyzing affection in the nervous system. 

Upon these features depends the method of electrical treatment. 
Your attention should be directed first to the primary disease and its ap- 
propriate electrical treatment instituted. I need add nothing here to my 
previous remarks concerning the treatment of diseases of the spinal cord, 
peripheral nerve affections, hysteria, etc. Nor do I wish you to believe 
that I regard electrical treatment as the sole remedy for these primary 
diseases ; on the contrary, I know that much is effected by other meas- 
ures, indeed often more than by electro-therapeutics. 

In addition to this causal treatment and in the not infrequent cases in 
which this is impracticable, direct treatment of the vesical paralysis must 
also be employed. It may be effected in various ways — percutaneously, 
with moist electrodes, or internally, by means of a catheter, with the fara^ 
die or galvanic current 

In the percutaneous method, one pole (as a rule, the An) is applied to 
the region of the lumbar enlargement upon the lower dorsal and upper 
lumbar vertebrae, the other (Ca) upon the region of the bladder. If reten- 
tion is most prominent, the electrode is pressed in as deeply as possible 
immediately above the symphysis ; if incontinence constitutes the main 
feature, it is applied to the perineum as close as possible to the sphincter. 
If both parts of the muscular structure are affected, either both applica- 
tions may be made, or one pole is placed above the symphysis and the 
other upon the perineum. The galvanic current may be applied, stabile 
and labile, for a few minutes to these situations, and several interruptions 
and changes of polarity made. The current should be of such a strength 
that Ca CI produces vigorous contractions of the abdominal muscles when 
applied to their motor points. 



1 



348 £LE0TBO-TH£BAPEUn08. 

In the internal method, the An is applied in a similar manner to tbe 
lumbar region ; a catheter-shaped electrode, insulated as far as its metailio 
tip, is introduced into the urethra — as far as the neck of the bladder in 
incontinence, in order to stimulate the sphincter directly, and into the 
bladder itself (either full of urine or injected with lukewarm salt water) 
in case of retention. As a matter of course, care must be taken to disin- 
fect the catheter-electrode. With the galvanic current, brief Ca closures 
or a few changes of polarity with a very short period of closure may alone 
be made in order to avoid eschars ; it is best to regulate the strength of 
the current with the galvanometer. The faradic current may be quite 
strong, as the bladder is not at all sensitive, and the urethra very slightly 
so in its deeper parts. The strength of the faradic current may be 
measured also by the fact that, upon faradization of the sphincter, the lat- 
ter contracts at each closure of the current, and thus moves the catheter 
somewhat anteriorly out of the urethra. In faradization of the detrusor, 
it is serviceable to direct the current to all parts of the walls of the blad- 
der, the An being placed upon the abdomen to the right and left, and 
above the bladder, and also on the perineum ; the muscular contractions 
produced furnish a satisfactory measure of the strength of the ciurent. 
In internal applications the sitting should not be very prolonged. 

Finally, an application may be made within the rectum ; the An (an 
olive-shaped metallic electrode) is introduced into the rectum to the 
proper height, the Ca applied above the symphysis, and the galvanic or 
faradic current passed in the same manner as described above. 

In all obstinate cases of paralysis of the bladder I add usually a direct 
and vigorous galvanization of the lumbar cord, in order to stimulate di- 
rectly the centres for the innervation of the organ. According to circum- 
stances, I associate with this a vigorous labile cathodal application from 
the Cauda equina to the coccyx and perineum, or an application to the 
entire spinal cord as high as the cervical vertebrae. 

The results of treatment vary greatly in individual cases : they are 
usually very slight in transverse myelitis, compression, hemorrhage, etc., 
very much better in ataxia, in which electrical treatment often secures 
excellent palliative eflfects; very favorable, even brilliant, in hysterical 
forms and also in cerebral paralysis of the bladder, and likewise in certain 
toxic forms or in paralysis from unknown causea 

Nocturnal enuresis is a special form of weakness of the bladder, which 
constitutes an exti*emely grateful object of electro-therapeutics. This 
condition seems to me to be due, in the large majority of cases, to the 
disproportion existing between the profoundness of the sleep and the 
strength of the sensory irritation occasioned by the full bladder. At all 
events this holds true of all cases in which no disorder of micturition 
occurs during the day. But it is not always easy to determine what part 
should be attributed, in the individual case, to the abnormally deep sleep. 



SPECIAL ELECTRO-THEEAPEUTICS. 349 

and what to the diminished sensory irritability of the bladder and the 
neck of the organ. Gases undoubtedly occur in which the mere profound- 
ness of the sleep is the cause of the annoying affection ; in others there 
appears to be a dulness of the sensory excitability of the bladder. But it 
may also be attributed, perhaps, to an increased excitability of the vesi* 
cal centres in the lumbar cord, which leads to an imcontrollable reflex 
eyacuation of the bladder upon a slighter peripheral stimulus than nor- 
mal Finally, a certain weakness of the sphincter vesicae must be assimied 
in those cases in which more or less marked incontinence is present dur- 
ing the day. The site of the disturbance, accordingly, may be sought for 
in various localities —peripherally, in the lumbar cord, higher up in the 
spinal cord, perhaps even in the brain. As all other evidences of a gross 
lesion are absent, we must assume a functional disturbance of these tracts, 
probably dependent in many cases upon a neuropathic disposition. 

The treatment must be directed mainly to the bladder, preferably ac- 
cording to SeeUgmueller* s method. He introduces a metallic wire about 
one centimetre long into the entrance of the urethra, connects it with the 
Ca of the secondary faradic current and applies the An as the sponge elec- 
trode over the symphysis ; a current which can be felt distinctly should be 
passed for several minutes. The results are illustrated by the following 
case : 

171. Observation by SeeUgmueller, Nocturnal (and diurnal) enuresis, — 
A woman, aged twenty-two years. Suflfered since earliest childhood from 
incontinence of urine by day and night ; all possible measures proved use- 
less. Occasional remissions, varying from one to several months in dura-^ 
tion, during which the nocturnal enuresis disappeared but the patient 
was extremely inconvenienced by the affection during the day. During 
the last six months, the patient was awakened regularly two or three 
times during the night, and notwithstanding this precaution enuresis 
sometimes occurred. Very serious effects of the disorder upon the gen- 
eral condition, preventing the enjoyment of life, producing emaciation, 
hectic appearance, depressed mental condition. The faradic treatment, 
described above, instituted for five minutes ; immediate improvement 
after first sitting ; only urinated twice during the day, not at all at night. 
Normal condition after the third sitting. After eighth sitting, patient 
discharged cured ; recovery permanent ; general condition excellent. 

I apply iisually the An to the lumbar cord, the Ca at first above the 
symphysis, then upon the perineum, with a tolerably strong current for 
one to two minutes ; at the close, a wire electrode is introduced about two 
centimetres into the urethra — in girls I apply a '' small" sponge electrode 
between the labia close to the meatus urethrsB—and the faradic current 
passed for one to two minutes with such a strength that a distinct, some- 
what painful sensation is produced. 

In more obstinate cases I pass the urethral electrode as far as the neck 
of the bladder, or, in addition, I employ the electrical current in the man- 



1 



350 SLS0TBO-TH£BAPSUTI0S. 

ner described above ; at all events, galvanic applications always are made 
to the lumbar cord, and perhaps to the entire cord as to as Uie cervical 
spine. 

The results of electrical treatment are usually excellent, especiallj in 
older children or in adults ; improvement occurs after one or more sit- 
tings, recovery, as a rule, in a short period. However, protracted treat- 
ment is necessary sometimes, and I vnll not conceal the fact that electrical 
applications may prove entirely useless. 

Among the diseases of the male sexual organs^ the functional disturb- 
ances are particularly adapted to electrical treatment 

The statements made by Charon and Moreau-Wolf concerning their 
results from the galvanic treatment of inflammation, swdling and hyper- 
irophy of the prostate are not very credible, and have not been substanti- 
ated by othera These authors introduced a metallic electrode into the 
rectum, pressed it against the prostate (usually the Ca, the An only when 
marked tenderness was present) and applied the other electrode to the 
perineum. Currents of moderate strength, of five to ten minutes' dura- 
tion ; eighteen to twenty sittings altogether. The results were described 
as remarkably favorable, and the procedure as much more effective than 
other surgical and medical measures. 

These authors state also that similar results were achieved in blenor- 
'phoic and traumatic orchitis. The method consists of the stabile passage 
of a strong galvanic current through the enlarged organ (for six to eight 
minutes) ; then a stabile current from the most painful part of the swel- 
ling to the seminal duct (four to six minutes), and finally an ascending 
current along the seminal duct. This application is said to be followed 
forthwith by relief and recovery, and the latter is complete after a few 
sittings. These statements also require confirmation. I have mentioned 
them in order to attract the attention of those who employ electricity in 
this branch of medicine. 

Atrophy and Jlaccidity of the testicles which accompany many functional 
<lisorders and are due usually to onanism and sexual excesses, have also 
been treated by electricity and not without success. The method consists 
of the passage of moderately strong faradic or galvanic currents through 
the testicles for a few minutes, perhaps also galvanization of the seminal 
duct. 

The most important field for the electro-therapeutist is afforded by the 
frequent functional anomalies, which are manifested by various grades of 
impotence, pollutions, spermatorrhoea, and aspermatism. I cannot enter 
in detail into the pathology of these affections, but will mention that they 
are due in part to gross anatomical changes, to the sequelsB of inflamma- 
tions of the urethra, testicle, and epididymis, seminal duct, prostate gland, 
perhaps to new growths, etc. As a rule very little can be effacted by elec- 
tricity in such casea 



SPECIAL ELEOTBO-THEBAPEUTICS. 351 

Another part of the cases must be attributed to serious organic diseases 
of the peripheral or central nervous system ; here the disturbances of the 
sexual function, pollutions, impotence, spermatorrhoea, priapism, are 
merely the symptoms of a beginning locomotor ataxia, chronic myelitis, 
or compression of the spinal cord, or perhaps of a severe lesion of the 
nerves of the cauda equina, etc. It is well known that some diseases of 
the spinal cord often diminish or abolish the sexual function at an early 
period (especially in ataxia, transverse myelitis, compression, chronic men- 
ingitis), while it remains entirely intact in others (in the forms of polio- 
myelitis, spastic spinal paralysis, etc.). In the former, electrical treatment 
may be employed occasionally in order to act directly upon the disordered 
sexual function as a symptomatic remedy, or to relieve the debility which 
may have persisted after the recovery of the primary affection. However, 
the pos8ibmty of recovery or impr^ement .dwayTdepends mainly upon 
the primary disease, and, as Benedikt has rightly remarked, it is not al- 
ways a benefit to the patient to have this function restored at an early 
period, for an ataxic patient may suffer much injury from irritation of the 
spinal cord due to sexual intercourse. 

A third group includes those cases of disordered sexual function in 
which these are either isolated, due to local morbific influences, ordinarily 
to functional over-stimulation, and thus form the chief object of complaint ; 
or they occur merely as a symptom of a general functional neurosis, neur- 
asthenia, spinal irritation, hypochondriasis, or the like, or they develop 
upon the basis of a neuropathic disposition, of a general nervous weakness 
and irritability, perhaps upon the addition of other very slight injuries 
(sexual excesses, inflammation, and conditions of irritation or flaccidity in 
the urethra or region of the ejaculatory ducts). These are by far the most 
frequent forms and those ii^ which electrical treatment is specially indi- 
cated. They constitute generally the various stages of '' irritable weak- 
ness " of the sexual function and lead to diminished potency, premature 
ejaculations, imperfect erection, abnormaUy frequent nocturnal pollutions, 
finally to daily pollutions and spermatorrhcea. These conditions are ac- 
companied, as a rule, by a host of other nervous symptoms, by manifesta- 
tions of neurasthenia and particularly by marked hypochondriacal depres- 
sion. 

In addition, cases occur which do not belong to any of these groups, 
in which, for example, absolute impotence or abnormal pollutions or 
aspermatism are observed in otherwise healthy men, with a pure previous 
history and without any signs of disease of the genitals or nervous sys~ 
tem ; and finally certain of these disorders may be due to diabetes, lead 
poisoning, alcoholism, and the like. 

All these manifold conditions have been treated more or less success- 
fully by various observers with electricity. 

The method of treatment depends, as a matter of course, upon the 



1 



352 ELEOTBO-THSBAPEUTICS. 

primary disease, and in many cases this ia the essential feature. I r^r 
you accordingly to my previous remarks upon the treatment of diseases of 
the brain and spinal cord, still more of neurasthenia and allied conditions. 

As a rule, however, the majority of cases also require direct electrical 
treatment of the genitals, and this may constitute the main feature of 
treatment if the sexual disorder is the sole or predominant symptom. 

In the large majority of cases we must stimulate and invigorate the 
nervous functions, relieve paretic conditions of the lumbar cord and the 
genital nerves ; in much rarer instances, conditions of abnormal irritation 
must be relieved. 

As a general thing the galvanic current is preferable. The following 
is the method which I consider most serviceable : the An (''large" elec- 
trode) is placed upon the lumbar cord, the Ca (''medium" electrode) 
stabile and labile along the seminal 'canal from the inguinal ring down- 
ward, for one to two minutes on each side ; the current should be tolera- 
bly strong, so that a distinct burning sensation is produced in the integu- 
ment Then follows vigorous labile application of the Ca (about a minute) 
to the upper and lower surfaces of the penis as far as the glans ; finally 
the Ca may be applied labile and stabile upon the perineum as far forward 
as the root of the penis (one to two minutes) ; a few interruptions or 
changes of polarity may be made in order to secure more active stimula- 
tion. If the penis, especially the glans, is ansesthetic, the Ca may be ap- 
plied in this position for a longer period. If the testicles are atrophic, 
flaccid, and the scrotum cool, the current may be passed directly through 
them. 

This method of application is suitable especially in impotence ; if pol- 
lutions or spermatorrhoea are present, the irritant procedures should be 
avoided, and stabile currents should be employed in great part, perhaps 
also the An upon the perineum. If there is reason to believe that the sper- 
matorrhcea is produced or maintained by conditions of irritation or flaccid - 
ity in the region of the ejaculatory ducts, these parts should be treated 
directly by means of the urethral electrode ; this is introduced as far as 
the prostatic portion, the An being employed in conditions of irritation, 
the Ca in conditions of flaccidity ; the current should be moderately 
strong, but of very short duration. 

The faradic treatment of impotence and spermatorrhoea is not excluded 
by any means ; the electrodes may be applied in the same manner as in 
galvanic applications, and moderate currents should be employed. Fara- 
dization of the testicles has been recommended also in poor nutrition and 
slight turgescence of these organs ; Guenther states that he has employed 
it successfully in azoospermia. In ansesthesia of the integument or strik- 
ing coldness of the penis, flaccidity of the scrotum, etc., the faradic brush 
may be applied to the genitals to advantage (also to the perineum and 
the anal region, from which vigorous reflex contractions of the scrotum 



SPECIAL EiKCTBO-THSBAPSUTICS. 353 

may be secured). Moebius suggests the application of an electrode 
wiUiin the rectum, in order to come in closer proximity to the ejaculatory 
ducts and the prostate gland ; the other electrode is applied to the peri- 
neum, and the faradic current passed for two or three minutes ; in conclu- 
sion, a short galvanic application is made, the Ca in the rectum, the An 
upon the sacrum. 

In severe or obstinate cases I never omit regular galvanic treatment of 
the lumbar portion of the spinal cord, which contains the most important 
centres of the genital function. In cases of supposed anatomical lesions, 
I add the galvanic treatment of the cauda equina, the applications being 
extended generally to the cervical cord, especially in patients in whom we 
suspect a general weakness of the entire genital nervous system. 

The treatment must be continued for a long time, at least six to eight 
weeks (daily sittings), and often much longer. It may be combined profit- 
ably with other measures of treatment. 

The results which I obtained by these methods were often very satis- 
factory, particularly in the purely functional forma But I have met also 
with cases which presented apparently a good prognosis, yet resisted elec- 
trical treatment entirely. It is well, therefore, not to promise too much — 
apart from those cases in which we have to deal with a sort of psychical 
impotence. 



Many individual observations and a few more extensive works have 
been published concerning the electrical treatment of diseases of the female 
sexual organs. 1 have had no personal experience in this field, and must 
confine myself, therefore, to a brief reference to the most important obser- 
vations which have been published. 

An entire series of observations have been made upon the electrical 
treatment of disturbed menstruation (Rockwell, Baker, Althaus, Taylor, 
Fieber, Good, Dixon Mann). 

The electrical current often produces very striking beneficial effects in 
amenorrhcea, whether it persists for a long time at the period of puberty, 
or has developed at a later period from other causea It has been often 
observed accidentally by electro-therapeutists, that during electrical treat- 
ment) especially galvanization of the back and legs or general faradization, 
the menses became more profuse or appeared prematurely. 

The direct electrical treatment of amenorrhoea may be carried out in 
the following ways : 

With the faradic current, the application of the brush to the soles of 

the feet or the inner surfaces of the thighs, or the passage of the current 

from the neck to the uterus. In addition to galvanic treatment, Dixon 

Mann also employs direct faradization from the loins to the cervix uteri at 

the time of the expected menstruation. 
23 



1 

I 



354 ELEOTBO-THEBAPEtnOS. 

The majority of observers, however, have preferred the galvamc cur- 
reni The following methods may be adopted : galvanization of the c^^ 
vieal sympathetic (Fieber, Oood) ; in addition, galvanization of the sfnne, 
especially its lowermost parts (Clemens, Grood) ; also galvanization from 
the lumbar region (An) to the ovaries (Gk>od, Althaus), and finally intra- 
uterine galvanization (Dixon Mann, Althaus), either by the introduction 
of the Ca into the uterus, the An being applied to the lumbar cord or the 
ovaries, or by the ap^^cation of the An to the os uteri and the Ca upon 
both ovaries in succession. The uterine electrode may be a catiieter- 
shaped instrument or a small sponge electrode or a small flat cervix elec- 
trode. The current should be moderately strong, two to three sittings a 
week, each ten to fifteen minutes in duration. The results are said to be 
often surprising. 

I have mentioned previously that electrical currents may prove success- 
ful in dysmenorrhoea. I will remind you of the observations made by 
Neftel in such conditions, and which were regarded by him as visceral 
neuralgias (Lecture XXVL, page 258). In such cases of painful spas- 
modic menstruation, you may try NefteFs method first (An upon the dor- 
sal and lumbar vertebrae, Ca upon the hypogastrium, ovaries, etc) ; also 
tlM following methods : according to Schwanda, alternating faradic and 
galvanic treatment of the uterus ; or, according to Taylor, the application 
of feeble continuous galvanic currents, the An upon the small of the back, 
the Ca in the form of a suitable metallic staff in the os uteri. Probably 
the best method is that of Dixon Mann, viz., the An in the uterus (uter- 
ine electrode), the Ca upon the lumbar spine stabile for ten minutes, three 
times a week during the inter-menstrual period. 

It was to be expected d priori that menorrhagia (and metrorrhagia in 
the broader sense) could be influenced favorably, under certain circum- 
stances, by the electrical current, |)articularly on account of its vigorous 
stimulating action upon uterine contractions. Indeed, favorable results in 
this affection have been reported by various authors. Thus, Mackintosh 
observed cessation of a violent hemorrhage, after the delivery of the child, 
fxom the application of the &radic current to the cervix uteri and abdomen 
and the consequent production of uterine contractions. Dixon Mann has 
cured the afiection by galvanization of the uterus (Ca in^ the uterus. An 
upon the loins, twice a week for fifteen minutes, with a tolerably strong 
current) in the intervals between the menstrual periods. 



Among the changes in the uterus itself^ chronic mehriHa partioularfy 
has been the subject of electro-therapeutic experiments. Beau and Tripier 
employ the faradic current The former applies a moist sponge eleetrode 



8FB0IAL SLECrBO-THXBAPEUnCS. 855 

to the 08 uteri, the other electrode to the abdomen ; Tripier introduces 
one electrode into the uterus, the other (which is bifurcated) into the 
rectum and upon the anterior abdominal wall, or he faradizes percuta- 
neouslj (in yirgins) from the abdomen to the sacrum. Bartholow applied 
the galyanic current, the An (per speculum) upon the os uteri, the Ca 
upon the hjpogastrium, two to three times a week, stabile for five to ten 
minutes. Dixon Mann introduces into the uterus the Ca of a tolerably 
strong current, and places the An upon the lumbar region ; a few inter- 
ruptions of the current at the dose. 

Displacements of the uterus have also been treated by the electrical 
eurireni Such treatment is not devoid of promise in those cases in which 
they are due in the main to relaxation of the walls of the uterus ; in many 
other cases there is very little hope of relief from such measures. 

Even Simpson had recommended a sort of electrical intrauterine 
pessary in displacements of the uterus as well as in chronic metritis ; 
favorable results from electrical treatment of versions and flexions have 
been since reported by various observers. While Bartholow employed 
the galvanic current exclusively, E. Mann used galvanism and faradism 
alternately ; the majoriiy of writers, however, applied the faradic current 
alone, in order to produce vigorous contractions of the uterus and thus 
rdieve the change of position. As a rule, the current was passed from 
the 08 uteri to the abdominal walls. Zannini introduces one electrode 
into the rectum, the other into the uterus, and faradizes for five or six 
minutes with a current of gradually increasing strengtL 

Tripier has developed these methods most elaborately ; in anterior 
versions and flexions he faradizes the posterior surface of the uterus with 
a suitable electrode, which is placed in the rectum ; in similar posterior 
displacements the anterior surface of the uterus is faradized from the 
bladder or abdomen ; in both cases a (negative) electrode is introduced 
into the uterus. In prolapsus uteri, he states that good results have been 
observed from " bi-inguino-uterine " or " bi-inguino-vaginal " faradi- 
zation. 

I will refer also to the attempts which have been made to stimulate 
the insufficient secretion of milk by means of electrical currents. That 
this has been effected in a series of cases is evident from the observations 
of Aubert, Becquerel, Lardeur, and Estachy. Various methods of applica- 
tion are possible, but the majority of authors have applied the current di- 
rectly, by means of moist electrodes, to various parts of the breasts ; the 
current should be moderately strong. The secretion of milk has re- 
turned as a rule after two or three sittings of ten to twenty minutes' 
duration. Static electricity has also been recommended as very service- 
able. 

In conclusion, permit me to make a few brief remarks which are 
perhaps of practical interest and to which there v^as no previous oppor- 



356 SLBOTBO-THEBAPBUTIOS. 

tuniiy of referring. It has probably struck you that daring our entire 
presentation of the subject the contra-indications to the use of elecfaricitj 
have not been considered in detail But if jou examine somewhat more 
doselj into our conception of contra-indications with reference to the or- 
dinary medicinal remedies, you will acknowledge that there can be scarcely 
any question of their existence with regard to a remedy which, like elec- 
tricity, is capable of such an extraordinarily minute gradation and such a 
minimum dosage ; which may produce the most varied, even antagonistic 
effects, here stimulating, there sedative, now tonic, again alterative in its 
action. And indeed, dfter a careful consideration of the subject, I must 
admit that I cannot present an absolute contrarindication ; at the most, 
this may be presented not infrequently in the individual case, and then 
merely with regard to one or another form of application, rarely witli 
regard to electricity in general 

In this respect) the condition of the circulation and blood-vesseb seems 
to me to demand the chief consideration. One of the most striking 
effects of electricity is dilatation of the blood-vessels and increased flow of 
blood. The employment of electricity, at least the application of those 
methods which increase the flow of blood, is contra-indicated therefore in 
all cases in which increased blood-pressure or hypersemia may entail 
danger on the patient It should be avoided accordingly in acute in- 
flammatory conditions, and especial caution must be employed in its ap- 
plication to individuals with sclerotic or atheromatous vessels, miliaxy 
aneurisms, hypertrophy of the heart, etc. 

In the next place, the condition of the nervous system in general, its 
greater or less irritability, the manner of its reaction to the electrical 
stimulus, may be decisive with regard to the question of the applicability 
of electrical treatment. There are individuals who experience, in the 
good as well as the bad sense, a striking effect from electrical currents, 
while others are influenced thereby to a very slight extent Nervous, 
neurasthenic, hysterical individuals often present an extremely high grade 
of " susceptibility," so that very feeble currents increase their sufferings. 
As a matter of course, this condition constitutes a contra-indication to the 
employment of electricity, while the milder grades of susceptibility 
merely afford grounds for extreme caution in the selection of the strength 
of the current ; it is found not infrequently that such individuals become 
tolerant to electricity after prolonged treatment In many cases, indeed, 
this very susceptibility of the patient is a not unfavorable prognostic 
factor with reference to the effects of electrical treatment. 

I have now finished, and believe that I have given you a tolerably com- 
plete picture of the present status of electro-therapeutics in internal medi- 
cine. I am well aware that many gaps have been left, that there are many 
additional details which might have been communicated, and particularly 
that there is much which required more careful investigation before it was 



SPECIAL ELEOTBO-THSBAPSUnCS. 857 

made ihd basis for practical work. I hope that these gape have not 
escaped your notice. And I trust that the subject has been presented in a 
clear light, and that, so far as lay in my power, at least, the way has been 
pointed out which should be followed among the confusing multiplicity 
of practical conditions. Although I haye laid down clearly the principles 
and scientific basis of the practical manipulations which must be modified 
in so many ways, it has also been my object to unfold to you the scanty 
and uncertain condition of our actual knowledge in this field. 



\. 



INDEX. 



ABDOMnrAL moMlM, pttrslyBis of, 908 
Acomtio nerre, law of oontmotioo of, 48 
dmple galvanic hypenwthesia of, 96 
galTamo hypenMthem of « with anom- 

a]j af normal f ormola, 90 
paradox reaction of, 97 
anomalj of reaotion of, withoot hj- 

penesthesia, 100 
torpor of. 101 
AotiTO eleoferode, 69 
Aonto anterior poliomyelitia, 175 
Aoate aaoending paralyiii, 179 
Aoote inflammatKm of joints, 889 
Ageiuifl, 824 

AMiblyopia aad amaurosis withoot anato- 
mical lasion. 814 
casss : cerebral scotoma, 814 ; oon- 
reigent strabismus, marised ambljo- 
pia of one eje, 814 ; tranmatio an- 
aBsthesia of retina, 814 
Amenorrbcea, 868 
Amyotrophic lateral sderosis, 179 
AnMthesia, 878 
etiology, 878 

electrical examination, 274 
tseatment, 276 

oases : anaosthesia of trigeminns, 275 ; 
traumatic anassthesia and paralysis 
of ulnar and median nerves, 275 ; 
anaasthesia of ulnar nerve, 275 ; le- 
sion of right cerebral hemisphere, 
left hemianaostbeaia, 275 ; right cere- 
bral hemiansesthesia, 276 ; right hys- 
terical hemianaBsthesia, 276 
Anassthesia of trigeminus, 278 
of pharynx and larynx, 278 
Tasomotor, 278 



Anassthesia, hystarloal, 271 

ataxic, 279 
Angio-neoroses, outaneons, 289 
Angio-paralysis, cutaneous, 288 
Angio-spasm, cutaneous, 288 
Aneleotrotonns, 42 
Angina pectoris, 254 

methods of treatment, 965 

oases : idiopathic angina peotoffis, 956; 
angina pectoris, 256 
Anidroaiii, 286 
Ankylosis, 882 
Anode, 4 

Anodal action, 109 
Anosmia, 825 
Aphonia, hysterical, 994 
Apophyseal point of Tronsssau, 
Arthritis deformans, 881 
Articular neuroses, 252 
Artificial respiration, 224 
Ascites, 344 
Asthma, nervous, 888 
Asphyxia, 224 
Athetosis, 802 
Atony of vocal cords, 294 
Atrophy of optic nerve, 810 

primaiy, 812 

genuine, 818 



Babbdow^s disease, 808 
Bladder, Bpa&m of, 846 

weakness and paralysis of, 846 

etiology of, 847 

treatment of, 847 
Blepharospasm. 270 
Brain, effects of electricity upoUi 68 



360 



INDEX. 



Bialo, direct treatment of « 148 

indirect treatment of, 150 

•ymptomatio treatment of, 151 

electro-diagnosis of, 151 

diseases of, action of electricity in, 
138 

cases: cerebral neurasthenia, 139 ; 
emotional neurosis, hemiparesis of 
right side, 139 ; insomnia, mental 
depression, 189 ; hypersemia of the , 
brain (?), cerebral neurasthenia, 
140; right hemiplegia (from cere- 
bral hemorrhage ?), 140 ; cerebral 
hemiplegia, sudden considerable im- 
proTcment of the paralysis, 141 ; 
right hemiplegia, sudden improve- 
ment, 141 ; right hemiplegia and 
aphasia (from embolism ?), 141 ; 
hemiplegia, probably from hemor- 
rhage, 148; monoplegia of right 
arm with complete anaesthesia (prob- 
ably from hemorrhage), 142; left 
hemiplegia (from hemorrhage ?), 
143 ; monoplegia of right arm (from 
embolism?), 143; right hemipare- 
sis (anatomical diag^nosis uncertain), 
143; tremor of head, attacks of 
vertigo (incipient multiple sclero- 
sis ?), 148 ; left hemiplegia after 
acute encephalitis, 144 ; paralysis of 
numerous bulbar nerves, 144 ; bul- 
bar symptom-complex (Erb), 145 

Oardialqia, 256 
Catalepsy, 301 
Cataract, 808 
Catalysis, direct, 107 

indirect. 110 
Catelectrotonus, 42 
Cathode, 4 
Cathodal action, 110 
Central galvanization, 118 

myelitis, 173 
Cerebral hemorrhage, 153 

vessels, action of electricity upon, 188 

vessels, reflex action upon, 138 
Oervico-braohial neuralgia, 249 
Cervico-oocipital neuralgia, 246 
Choked disk, 309 
Chorea magna, 297 

minor, 298 



Choroid, diseases of, 809 

case : chronic retino-choroiditis, 809 
Chronic meningitis, 154 

inflammation of joints, 380 
Ciniselli's simple element, 120 
Circular current of Bemak, 252 
Circuit of closure, 3 
Concussion of spinal cord, 171 
Conditious of mental depression and exal* 

tation, 157 
CJolic, 257 

Conducting wires, 14 
Conduction, resistance to, 21 

variations in, 22 
Constancy of elements, 9 
Contact electricity, 2 
Contractions, diplegic, 92 

galvano tonic reflex, 98 
Contra-indications to use of eleotrioitj, 856 
Convulsible reaction, 89 
Convulsions, nature of, 259 
pathogenesis, 260 
electrical examination, 261 
methods of treatment, 267 
cases : facial spasm, 268 ; bilateiai 
facial spasm (blepharospasm), 268 ; 
clonic spasm of .facial musdes, 264 ; 
spasm of splenius, 264; spasm of 
neck muscles, 264 ; rheumatic torti- 
oollis, 265 ; oontracture of levator 
anguli scapube, 265; nervous per- 
tussis, 265 ; singultus with weak- 
ness of arm, 265 ; spasm of recti 
abdominis and latissimi dorsi, 265 ; 
tremor of right arm, 265 ; donio 
spasm of lower limb, 266 ; hemi- 
plegic contracture, 266 ; rheumatic 
oontracture, 266 ; contraotuxe in 
compression-myelitis, 266; hysteri- 
cal contracture, 266; reflex oon- 
tracture of quadratua Inmboram, 
266 
Convulsive tic, 270 
Cornea, ulcers of, 807 
Current, faradic, 2 
galvanic, 2 
density of, 27 
diffusion of, 28 
methods of localization of, 80 
electrolytic action of, 81 
mechanical action of, 32 



INDEX. 



861 



Conent, oataphorio aotion of, 89 

stiiiiQlatiDg effects of, 105 

modifying effects of, 106 

catalytic effects of, 107 
Outaneona angiospasm, 388 

angioparalysis, 283 

DBomSBATiON reacUon, 74 
irritability of nerres in, 76 
ixritability of mnsdes in, 76 
anatomical appearances of nerves in, 

79 
anatomical appearances of mnadee in, 

80 
partial, 89 
oooorrence of, 88 

importance of, with regard to progno- 
sis, 86 
doalile contraction in, 87 

Densitj of the current, 97 

Diabetes mellitos, 804 
insipidus, 806 

Diiq>hragm, paralysis of, 908 

Diminution of secondary irritability, 89 

Diphtheritic paralysis, 225 
symptomatology, 225 
electrical examination, 296 
cases : ataxia, 226 ; dij^tharitio par- 
alysis, 227 
methods of treatment, 227 

Diplegic contractions, 99 

Diseases of the brain, 187 

of the medulla oblongata, 164 

of the spinal cord, 160 

of the peripheral nerves, 180 

of the cervical sympathetio, 980 

of the organs of special sense, 806 

of the organs of locomotion, 897 

of the glands, 839 

of the thoracic viscera, 888 

of the digestive apparatus, 886 

of the urinary and sexual organs, 846 

Dubois-Reymond's law of irritation, 88 

PysmenorrhoBa, 854 

Dyspepsia, nervous, 887 

S\R, electrical examination of, 66 

Ectropinm, 307 

Electricity, contact, 9 

Electrical bath, 118 

Electrical currents, reflex eflbcts of, 119 



Electrical brush, 18 

moxa, 949 
Electrical irritability of motor nervee and 
muscles, increase of^ 60 

irritability of motor nerves and mus- 
cles, diminution of, 71 

irritability of sensoxy nerves, changes 
in, 93 

irritability of sensory nerves, hypersM- 
thesia of, 98 

irritability of sensory nerves, anaastho- 
sia of, 98 

irritability of optic nerve, changes in, 96 

irritabiUty of acoustio nerve, ohangea 
in, 96 
Electrodes, 6, 15 

active, 88 

indifferent, 88 

for general faradisation, 116 

unpolariieable, 17 
Electrolysis, 31 
Electrolytes, 31 
Electrolytic effects, 66 
Eleotro-motor power, 8 
Electro-muscular sensibility, 46 

sensibility examination of, 67 
Electro-therapeutics, electrotonic thooi:y 
of, 104 

stimulation, theory of, 104 

catalytic theory of, 106 

polar method of, 118 

direction method of, 118 
Electrotonic action of current^ 49 
Electrotonus, 49 
Elements, constancy of, 9 
Element numerator, 11 
Endolaryngeal electrisation, 998 
Endopharyngeal electrisation^ 998 
Enteralgia, 957 
Entropium, 307 
Enteropathy, nervous, 889 
Epilepsy, 904 

treatment of, 996 
Epileptic insanity, 168 

change, 994 
Essential cyanosis, 988 

redness, 983 

resistance of a chain, 96 
Examination, polar method of. 69 
External auditory canal, abnormal drynsM 
of, 317 



ssa 



INDBX. 



Bztenud Mn, aleoteo-fhjriolttgy ol, 69 
Bztra-eMential ledstanoe, 25 



Bj^e, eleotrioal •WMnmatfop. of, M 

Facial nerrt, paialTiis of, IM 

ipMm ci, 270 
Fazadio canent, 2 
Fttadiflatian, genaral, 116 

looal, 121 
Fttacitional dkoMei of tiie oovd, 171 

nieiizotes, 288 

Oalwanio evBwt, 2 

taite, 49 

▼eriic^, 68 
Ck^Tanisation of the nook. 111 

of the ^mpathetio, 111 

genevd, IIV 

oentral, 118 
Galyanometer, 18 

Hinohmaim*8, 18 
Oalvano-caatezy batteziM, 28 
Oalvano-tonio reflex oontraotioas, 98 
Gall-bladder, efltocto of eleotrioitgr upon, 
Gaatralgla, 256 
fl—irnl fnmdinrtiflm. 116 
Olobna h jstezioaa, 294 
Goitre, 883 
Gustatory nerPM, nenxoMS of, 8M 

Hbadachs, 247 

Heart, norrooa palpitatka of, 881 

weakneas and irregolaxitj of, 886 
Hemeralopia, 816 
Hemianopeia, 815 
Hemiorania, 2417 
Herpes aaoter, 286 
Hemorrhages into the braiiit 168 

into the spinal oord, 172 
Hiooongfa, 271 
Hydrooephalns, 154 
^drops artUmlomm intermitism, 266 
H^peridrosis, 286 
Hyperkineses, professional, 295 
Hypoohondriaoal melanoboiia, 158 
Hypoohondriasis, 292 
HypoKlosaal nerve^ paalyiis of, 204 
Hypopyon, 307 



64 



Hystezioal psychoses, 157 



Hysteiioal fandjraiib 
annstheaia, 294 
oonvnlsioaB, 294 
aphonia, 294 



Impotbncb, 852 
Inocmdnenoe of nrine, 846 
Increase of seoondaiy irritahU^iri 
Indifferent elootrode, 88, 59 
Indirect ostalysis, 110 
Indaotion, eleotikllQr, 6 

apparatus, 5 
infMEtile spinal panilhfqris, 179 
electrical examination, 176 
treatment, 176 
Insomnia, 158 
Inteaupt im r hMdIa, 17 
Intercostal neoralgia, 250 
Intestines, effects of eleuttkiity 
oodnsion of, by stasis of 
inyagination of, 841 
atony and oonstipatioa, 3tt 
atony and oonstipation, 
^y, ssvoBS conatipatioii, B41 ; 
headache, haMaal 
841; gunshot woomI of 
and ^p in^^ obstlBate 
•41; obsthiate 
peritonitis, 842 ; hafaitiMl 
tion, 842 
Ions, 82 

Irritability of ne nos , 
minatioBof, 60 
with faradio oorvsnl, 62 
with galyanio ourrent^ 62 
Isdhuzia, sp asmo d le, 846 



56 




after 



JOINTB, 



of, 882 



Katatonia, 157 
Keratitis, 

paialytio, 807 



Labile action, 106 

Latent period of irritatioB in 

ulation of musoles, 91 
Lateral sclerosis, amyotrophie, 171 

descending, 179 
Law of contraction of nerrss, 88 

qualitatiTC changes in, 90 
Lead palqr, 228 



unaoL 



S6S 



•kotro diagnosis d29 

treatment, 280 
LiTor angio-neozoticiis, 268 
Iiooal faxadiaation, 121 
Ljiniiliatio glanda, enlargement of, 882 

Maonbto-blbotbical apparatoa, 5 
Kale aeznal oigana, f nnotioiial disturb- 
anoes of, 850 

^jmptomatology, 801 

treatment, 850 
Melanoholia, 158 
Menidxe'a diaeaae, 824 
Meningeal apoplezj, 171 
Menordiagia, 854 
If etritia, 854 
Migraine, 247 

nature, 248 

treatment, 248 
Milk, deficient secretion of, 805 
MilUveber, 18 

Modifying action of onrrent, 42 
Monoarticnlar chronic articular iheama- 

tlsm, 880 
Motor norves, law of oontiaolion oiy 88 
Moza, electrical, 242 
Multiple sdesoeis, 154 
Muscles, law of ccmtraotion of, 40 
Muscles of mastication, paralysia of, 109 
Muscular atrophj, 281 

eleotfo-diagnosis, 281 

treatment, 288 

eases : paralysis and atrophy of quad- 
riceps from gonitis. 282 ; traumatic 
hydrarthrosis of knee, atrophy of 
quadriceps, 232 
Muscular rheumatism, 827 
Blyalgia,827 
Mydriasis, 108 
MyeUtifl, 173 
Myotonia congenita, 288 

Neck, galTaniaation of, 111 

Negative pole, 4 

Nerres, different reaotion of, to fandic 

and galyanic currents, 01 
Nervous asthma, 888 
Kerrous deafness, 828 

deafness without demonstrable 
anatomical change, anomalous gal- 



TBDio* reaetion, 828 ; deafness wHk 
anatomical change, tocpor of aoon^ 
tic nerve, 324 
Nervous exhaustion, 200 
Neuralgia, 284 
nature, 285 
symptomatology, 280 
electrical examination, 280 
treatment, 240 

oases: intermittent supra-<»bital neu* 
ralgia, 287 ; trigeminal neuralgia 
288; occipital neuralgia, 288 ; noB- 
ralgia of median nerve, 288 ; neural- 
gia of radial nerve, 288 ; neuralgki 
of lesser internal cutaneous nenet 
239; intercostal neuralgia, heqpQS 
zoster, 289; intercostal nensalfia, 
mastodynia, 289 ; sdatica^ 280, 240; 
neuralgia of foot from artisakyr 
rheumatism, 240 
Neuralgia of lumbar plexus, 250 

of urinary and sexual organs, 202 
of joints, 262 

of pharynx and larynx, 254 
of oasdiac nerves, 254 
of gastric nerves, 256 
of intestinal nerves, 257 
of pelvic nerves, 257 
Neuralgic change, 285 
Neurasthenia, 290 

qrmptomatology, 200 
treatment, 291 
Neuritis, qptk, 810 

retrobulbar, 810 
Neuroses of gustatory nerrea, 824 

of olfactory nerves, 825 
Nocturnal enuresis, 848 
Nystagmus, 315 

00UL4B muscles, paralysis of, 106 
(Esophagus, efleots of eleotriciij vpeo, 06 

spasm and paralysis of, 886 

sensory neurosis of, 886 
Ohm's law, 10 

Olfactory nerves, neuroses of, 825 
Opadties ^f tympanum, 817 
Open chain, 3 

element, 8 
Optic nerve, law of oontnotion of, 46 

atfophy of, 810 

primary, 812 



364 



USTDTSX, 



Optio nerve, atrophy of, genuine, 318 
oftses : atrophy of optio nerres, 813 ; 
beginning atrophy of optio nerves, 
813 ; white atrophy of optio nerves, 
813, 814 

Optio neuritis, 810 

oases: optio neuritia and subacute dor- 
sal myelitis, 810; optio neuritis 
with transverse myelitis, 810; neu- 
ritis with atrophy of optio nerve, 811 

Orohitis, blenorrhoio and traumatic, 350 

Organs of locomotion, diseases of, 827 

Pain, nature of, 285 

Painful points of Valleix^ 110, 288 

PalpiUtion of heart, 885 

Papillitis, 309 

Papillo-retinitis, 309 

Paralysis, definition of, 187 

causes of, 187 

sequts^dB of, 187 

treatment of, 1881 

reflex stimubtlon in, 189 

electro-diagnosis of, 198 

occurrence of degenerative atrophy 
in, 194 
Firalysis agitans, 802 

after acute diseases, 228 

of deglutition, 219 

qrmptomatology, 219 

electro-diagnosis, 220 

treatment, 221 

oases : paresis of velum palati, 220 ; 
diphtheritic paralysis of velum pa- 
lati, tensor of choroid and sphincter 
of pupil, 220; diphtheritic paraly- 
sis, 220 

of fadal nerve, 199 

forms of, 200 

treatment of, 202 

of hypoglosMd nerve, 204 

of laryngfeal mnsdes, 222 

of lower limbs, 214 

etiology, 215 

symptomatology, 215 

electro-diagnosis, 216 * 

treatment, 218 

oases : paresis of crural nerve, 216 ; 
paresis of sciatic nerve, hypertrophy 
of calf muscles, 216; psiadysis of 
peroneal nerve, 217; paralyses of I 



peroneal nerve from eicatriiation of 
bed-sore, 217 ; traumatio panlysa 
of peroneal nerve, 217 

of muscles of mastication, 199 

of muscles of neck and trunk, 205 

oases : paralysis of serratus mag^ns, 
207; paralysis and atrophy of dia- 
phragm, 207 ; progressive muMmlar 
atrophy (juvenile form), 207 

of ocular muscles, 196 

treatment, 198 

cases; rheumatic paralysis of abdu- 
oens, 197 ; paralysis of right ooalo- 
motor nerve, 197 ; paralysis of trooh- 
learis and insufBoienoy of rectos 
intemuB, 197; bilateral paresis of 
aectus intemus and rectus eztenni^ 
197 

of spinal accessory, 204 

of upper limbs, 208 

etiology, 209 

symptomatology, 209 

electro-diagnosis, 210 

treatment, 218 

cases: paralysis of musculo-outane- 
ous nerve, 211; paralysis of me- 
dian and musculo-cutaneouB nervea, 
211 ; paresis of ulnar nerve, 211 ; 
" crutch ^* paralysis of radial nerve, 
212; ''sleep" paralysis of radial 
nerve, 212; traumatic paralysis of 
radial nerve, 212; combined shoul- 
der-arm paralysis, 212, 218; trau- 
matio paralysis of radial, median, 
and ulnar nerves, 213 
Paralysis of vocal cords, 222 
Paralytic aphonia and dysphonia* 282 
Pathophobia, 292 
Periarthritic swellings, 882 
Periencephalitis, 154 
Peripheral nerves, diseases of, 180 

diseases of, available action of. deo* 
tricity in, 180 

diseases of, methods of application in, 
184 

diseases of, oases : chronic neuriUs of 
median nerve. 181 ; chronic neuritis 
nodosa of ulnar nerve, 181 ; neuritis 
of brachial plexus, combined shoul- 
der-arm paralysis, 181 ; paralysis of 
deltoid, 182 ; traumatio paralysis of 



INDEX. 



866 



left ann, 183; panljBiB of right 
radial nerve, 182; neuralgia of 
brachial plexus, 182 ; nearalgia of 
ulnar nerre, 188 ; right occipital 
and trigeminal neuralgia, 183 ; left 
■oiatioa, 188; right Bapraorbital 
neuralgia, 188 ; neuralgia of super- 
ficial branch of radial nerve, 183; 
trigeminal neuralgia, herpes labialis, 
183 ; retrobulbar optic neuritis, 184 ; 
white atrophy of optic nerve, 184 
Pflueger*s law of contraction. 34 
Pharynx, effects of electricity upon, 65 
Pharyngeal and laryngeal electrode, 221 
Polarity changer, 11 

Brenner*8 modification of, 13 
Polar method of examination, 59 
Polyarticular chronic articular rheuma- 
tism, 331 
Poles, means of recognition of, 18 
Portable batteries, 9 
Positive pole, 4 
Pressure points, 119 
Primary spiral, 6 

current, 6 
Professional hyperkineses, 295 
Prog^ressive bulbar paralysis, 154 
facial hemiatrophy, 286 
muscular atrophy, 177 
Prolapsus ani, 348 
Prostate, inflammation and swelling of, 

850 
Pseudo-hypertrophy of musdee, 383 
Psychoses, 156 

methods of application in, 157 
contraindications of electricity in, 159 



Railwat spine, 171 

Reaction of exhaustion, 89 

Rectal neuralgia, 258 

Reflex effects of electrical currents, 113 

Resistance to conduction, 21 

Respiratory paralysis, 224 

Retention of urine, spasmodic, 846 

Retina, law of contraction of, 46 

Retinitis pigmentosa, 309 

Ketino-choroiditis, 309 

Retrobulbar neuritis, 810 

Rheostat, 14 

Rheumatic torticollis, 371 



Bheumatismus nodosns, 881 
Rotation apparatus, 5 

SACROLUifBALBS, paralysis of, 308* 

Sciatica, 251 

Scleroderma, 287 

Secondary irritability, increase of, 89 

diminution of, 89 
Secondary spiral, 6 

Secretory nerves, electro-pbyBi<dogy of, 51 
Selector, 11 

Sensibility of skin, electrical examinatioD 
of, 66 
electrode for examination of, 67 
Sensory nerves, law of contraction of, 44 
Serratus magnus, paralysis of, 208 
Sexual organs, male, diseases of, 850 

female, diseases of, 858 
Siemen's unit, 21 
Simple element, 3 
Singultus, 271 
Softening of brain, 154 
Spasm in distribution of facial nerve, 370 
of muscles of mastication, 269 
in distribution of spinal acoessozy, 37Q 
of respiratory muscles, 271 
of upper limbs, 273 
of lower limbs, 272 
Spastic spinal paralysis, 174 
Spermatorrhoea, 853 
Sphincter, paresis of, 848 
Spinal accessory nerve, paralysis of, 304 
Spinal cord, effects of electricity on, 54 
diseases of, actions of current in, 160 
electrical applications in, 167 
action of poles in, 168 
indirect electrical treatment of, 168 
reflex irritation in treatment of, 169 
symptomatic treatment of, 169 
cases : subacute spinal meningitis, 
161 ; chronic spinal meningfitis (?), 
161 ; spinal concussion, 162 ; para- 
plegia (from acute myelitis f), 162 ; 
traumatic paraplegia, 162; myelo- 
pathy (tabes dorsaUs ?), 162 ; tabes 
dorsalis, 163, 164, 165 ; beginning 
tabes dorsalis (?), with atrophy of 
optic nerves, 163 ; affection of spinal 
cord (tabes?), 165; spastic spinal 
paralysis, 165 ; subacute anterior 
poliomyelitis, 165 ; chronic anterior 



866 



IITDBX. 



poliomyelitis. 106 ; pngtmdn 
calar atrophj, 166 
Spinal cord, oonoassion of, 171 

hemorrhage into, 173 

traumatic lesiona of, 173 

seoondaiy degeneration of, 179 

meningitiB, 170 

irritation, 1 73 

neoraathenia, 172 
Spleen, eff^ots of eleotridty on, 56 

enlaigement of, 388 
SIlffneM of joints, 883 
Stomach, effects of electricity on, 06 

atony and dilatation of, 888 
Snbaonte and chronic anterior poUo-myeli- 

tis, 177 
Snbanral galvanisation. 111 
Sympathetic system, eleotro-phyriology of, 
60 

galTanization of, 111 

irritation of, 381 

paralysis of, 381 

Tabes dorsaUs, direot eleotrioal treat- 
ment, 174 
qrmptomatio peripheral treatment, 174 
treatment of pressore and painfol 

points, 174 
spplication of faradio brash, 174 
Taste, electrical examination of, 66 

paralysis of, 834 
Tenesmus Tesicfs, 846 
Tension series, 8 
Tetanns, 393 
Tetany, 800 

Testicles, atony and flaoddity of, 860 
Thoracic yisoera, effeota of eleotridfy 

upon, 54 
Tinnitus aurinm, 817 
eleotro-diagnosis, 818 
methods of treatment, 831 
oases; simple gaWanic hypenesthesia 
with tinnitus aurium, 818, 830 ; tin- 
nitus aurium after administration of 
quinine, simple galvanic hyperaos- 
tbesia, 810 ; impairment of hearing 



Mid tianitne aorinm ; bilatsHd hy- 
persBsthesia of acoustic nerre, pasesii 
of abduoens nerve, 819 ; tinnitos an* 
rium and impairment of hearing, 
simple hypennstheds of bdh acous- 
tic nerves, 830 ; Chronic bvsang in 
head and tinnitus anrhun with im- 
pairment of hearing, lijpeiMlln'sis 
with paradox formula, 830; impair- 
ment of hearing and tinnitoa aori- 
nm, hyper»stiMsia with reversal of 
normal formula, 831 ; impairmeat of 
hearing and tinnitus anthun sfler 
oerebro-spinal meningitia, 8S1 

Torticollis, 371 

Transverse myelitis, 178 

Toxic paralyses, 380 

Traoboma, 807 

Tremor, 801 

Trigeminal neuialgia, 346 

Trismus, 369 

Trousseau's apophyseal point, 38i 

True hypertrophy of moaoles^ 313 

Unpolabizablb electrode, 17 

Urinary bladder, effects of eleotriolty on, 

55 
Urinary organs, diseases of, 846 

Yallbiz, painful points, 119, 386 
Yasomotor nerves, law of oontraotion of, 60 

anmtfaesia, 378 

neuroses. 383 
Yelum palati, efEeota of eleotilQil^ oa, 66 
Yertigo, 804 

galvanic, 58 
Yesical electrisation, 55 
Yirtual pole, 87 
Yisoeral neuralgias, 358 
Yitreous body, diseases of, 808 
YoHa's alternatives, 85 
Yomiting, nervous, 886 



WiBB biwdi, 18 
Writer's 



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